COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face...

88
ALERT: THIS PLAYBOOK IS BEING UPDATED FREQUENTLY AS NEW INFORMATION BECOMES AVAILABLE. PLEASE CHECK BACK FOR THE LATEST INFORMATION. COVID-19 Infection Prevention Acute Care Playbook Last update: 8/7/2020 10:15 am Update includes: Guidelines for PPE pg. 6-8

Transcript of COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face...

Page 1: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

ALERT THIS PLAYBOOK IS BEING UPDATED FREQUENTLY AS NEW INFORMATION BECOMES AVAILABLE

PLEASE CHECK BACK FOR THE LATEST INFORMATION

COVID-19 Infection Prevention Acute Care Playbook

Last update 872020 1015 amUpdate includes

Guidelines for PPE pg 6-8

Table of Contents

Chapter 1 Screening and Testing 3Quick Screen IPDH Criteria to Evaluate Patients for COVID-19 4

Chapter 2 Personal Protective Equipment (PPE) 5Guidelines for PPE 6

Personal Protective Equipment (PPE) Conservation 9

N95 RESPIRATOR PRODUCT UPDATE 14Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19 16

Important Update Regarding Air Pressure in OrsProcedural Areas 17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility 18

Chapter 3 Cleaning 19Chapter 4 Clinical Protocols 29COVID Awake RepositioningProning Protocol (CARP) 30

Instructions for patients with cough or trouble breathing 32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients 33

Chapter 5 Pressure Injury Prevention 37Protecting Facial Skin Under PPE N95 Face Masks 38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury 39

Pressure Injury Prevention PIP Tips for Prone Positioning 40

Chapter 6 Discharge Instructions 43FAQs for Patients 44

Home Isolation Instructions for 46

People with Coronavirus-2019 (COVID-19) Infection and People Awaiting COVID-19 Test Results 48 CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19) 50 CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel

Coronavirus (COVID-19) 51

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients 53

Chapter 7 Removing Isolation Precautions on COVID-19 Patients 55

Recommendations for removing transmission-based isolation precautions on COVID-19 positive patients 56

Chapter 8 Mortuary Care 57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients 58

Morgue Log - COVID-19 Log 60

Chapter 9 Contact Numbers 61Appendix 68

COVID-19 Test Orders in Electronic Health Records (EHR) 69

IDPH COVID-19 Order 70

Meditech Changes 71

Cerner Changes 72

Athena Changes 73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation 74

Personal Protective (PPE) Validation Checklist for PPE Monitor 75

PUI ISOLATION SIGN INOUT SHEET 76

Infection PreventionLeader Rounding Checklist 77 Discharge Instructions for Patients with COVID-19 in Spanish 78

Strategies to Optimize the supply of Personal Protective Equipment((PPE)) 10

[Click on section titles to jump to relevant section]

Chapter 1 Screening and Testing

3

Quick Screen IPDH Criteria to Evaluate Patients for COVID-19

Target Population for Evaluation ALL patients who present at an AMITA Emergency Department

AMITA is following the guidance of the Centers for Disease Control and prevention (CDC) forldquoCriteria to Guide Evaluation of PUI COVID-19rdquo at httpswwwcdcgovcoronavirus2019-nCoVhcpclinical-criteriahtml

Clinical Symptoms Epidemiologic Risks

Fever (ge1000) Cough Shortness of breath Loss of taste or smell

Sore throat

Myalgias (muscle pain) Headache

Chills

OR

Personal history of suspected or laboratory confirmedCOVID-19 within the last 14 days

Close contact with a person with suspected or laboratoryconfirmed COVID-19 within the last 14 days

Lives in assistive living or recently discharged from anursing homerehab facility known to have clusters ofinfluenza or COVID-19-like illness

IF patient answers YES to ANY Clinical Symptoms or Risk Factors

Patient at risk for COVID-19 like illness Triage patient appropriately

Physicians and APCs should Refer to ldquoTesting Decision Matrixrdquo as outlined by CDChttpswwwcdcgovcoronavirus2019-ncovsymptoms-testingtestinghtml

COVID-19 screening performed NEGATIVE for COVID-like illness Proceed with appointment

Updated 5120 Signature

4

Chapter 2 Personal Protective Equipment (PPE)

5

Guidelines for PPE August 7 2020

Adjustments in these guidelines are subject to changes in standards of care andor supply chain availability

Tier Situation PPE for Patient Care Activities

Tier 1 GreeterScreenerUniversal

Masking

Non PUICOVID-19 patient Standard precautions + universal masking

(follow isolation precautions if patients are on isolation for something other than COVID)

Tier 2 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

PUICOVID-19 not receiving aerosol generating

procedure (AGP) OR when collecting NP swab

Tier 3 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

ALL PATIENTSRegardless of COVID Status

receiving aerosol generating procedure (AGP)

AGP = Positive pressure ventilation (BiPAPCPAP) endotracheal intubation airway

suctioning high frequency oscillatory ventilation tracheostomy chest PT Nebulizer treatment sputum induction bronchoscopy

suctioning +

Centers for Disease Control and Prevention (CDC) httpswwwcdcgovcoronavirus2019-ncovinfection-controlcontrol-recommendationshtml Advent Health (2020) Standard Operating Procedures (SOP) Personal Protective Equipment Guidance for Novel Respiratory Virus COVID-19

N95 Masks with Exhalation valves

bull These devices have exhalation valves that we recognize do not filter

the exhaled air of the person wearing the device

bull The devices (respirators) with exhalation valves fill a necessary supply

gap with N95s for AMITA amp Ascension

bull Both respirators have been approved for use by the Ascension National

Infection Control team

bull These respirators are to be covered with a medical facemask if wearing

the device for universal masking purposes andor around patients with

unknown COVID statusother associatesproviders

bull AMITA amp Ascension do not support these respirators being covered with

a surgical face mask for use in the Operating Room for multiple

reasons 1) CDC does not support 2) they are not FDA approved for

surgery and 3) 3M does not support3M 8511

3M 6000 series N100

elastomerics

7

N95 Masks with Exhalation valves

bull The Envo N95 mask is NOT approved for use

bull Next Steps

1 SBAR from Ascension

2 Update AMITA PPE playbook

3 Share this information in huddles team meetings

local command center calls etc

Envo N95 mask

8

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 2: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Table of Contents

Chapter 1 Screening and Testing 3Quick Screen IPDH Criteria to Evaluate Patients for COVID-19 4

Chapter 2 Personal Protective Equipment (PPE) 5Guidelines for PPE 6

Personal Protective Equipment (PPE) Conservation 9

N95 RESPIRATOR PRODUCT UPDATE 14Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19 16

Important Update Regarding Air Pressure in OrsProcedural Areas 17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility 18

Chapter 3 Cleaning 19Chapter 4 Clinical Protocols 29COVID Awake RepositioningProning Protocol (CARP) 30

Instructions for patients with cough or trouble breathing 32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients 33

Chapter 5 Pressure Injury Prevention 37Protecting Facial Skin Under PPE N95 Face Masks 38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury 39

Pressure Injury Prevention PIP Tips for Prone Positioning 40

Chapter 6 Discharge Instructions 43FAQs for Patients 44

Home Isolation Instructions for 46

People with Coronavirus-2019 (COVID-19) Infection and People Awaiting COVID-19 Test Results 48 CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19) 50 CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel

Coronavirus (COVID-19) 51

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients 53

Chapter 7 Removing Isolation Precautions on COVID-19 Patients 55

Recommendations for removing transmission-based isolation precautions on COVID-19 positive patients 56

Chapter 8 Mortuary Care 57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients 58

Morgue Log - COVID-19 Log 60

Chapter 9 Contact Numbers 61Appendix 68

COVID-19 Test Orders in Electronic Health Records (EHR) 69

IDPH COVID-19 Order 70

Meditech Changes 71

Cerner Changes 72

Athena Changes 73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation 74

Personal Protective (PPE) Validation Checklist for PPE Monitor 75

PUI ISOLATION SIGN INOUT SHEET 76

Infection PreventionLeader Rounding Checklist 77 Discharge Instructions for Patients with COVID-19 in Spanish 78

Strategies to Optimize the supply of Personal Protective Equipment((PPE)) 10

[Click on section titles to jump to relevant section]

Chapter 1 Screening and Testing

3

Quick Screen IPDH Criteria to Evaluate Patients for COVID-19

Target Population for Evaluation ALL patients who present at an AMITA Emergency Department

AMITA is following the guidance of the Centers for Disease Control and prevention (CDC) forldquoCriteria to Guide Evaluation of PUI COVID-19rdquo at httpswwwcdcgovcoronavirus2019-nCoVhcpclinical-criteriahtml

Clinical Symptoms Epidemiologic Risks

Fever (ge1000) Cough Shortness of breath Loss of taste or smell

Sore throat

Myalgias (muscle pain) Headache

Chills

OR

Personal history of suspected or laboratory confirmedCOVID-19 within the last 14 days

Close contact with a person with suspected or laboratoryconfirmed COVID-19 within the last 14 days

Lives in assistive living or recently discharged from anursing homerehab facility known to have clusters ofinfluenza or COVID-19-like illness

IF patient answers YES to ANY Clinical Symptoms or Risk Factors

Patient at risk for COVID-19 like illness Triage patient appropriately

Physicians and APCs should Refer to ldquoTesting Decision Matrixrdquo as outlined by CDChttpswwwcdcgovcoronavirus2019-ncovsymptoms-testingtestinghtml

COVID-19 screening performed NEGATIVE for COVID-like illness Proceed with appointment

Updated 5120 Signature

4

Chapter 2 Personal Protective Equipment (PPE)

5

Guidelines for PPE August 7 2020

Adjustments in these guidelines are subject to changes in standards of care andor supply chain availability

Tier Situation PPE for Patient Care Activities

Tier 1 GreeterScreenerUniversal

Masking

Non PUICOVID-19 patient Standard precautions + universal masking

(follow isolation precautions if patients are on isolation for something other than COVID)

Tier 2 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

PUICOVID-19 not receiving aerosol generating

procedure (AGP) OR when collecting NP swab

Tier 3 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

ALL PATIENTSRegardless of COVID Status

receiving aerosol generating procedure (AGP)

AGP = Positive pressure ventilation (BiPAPCPAP) endotracheal intubation airway

suctioning high frequency oscillatory ventilation tracheostomy chest PT Nebulizer treatment sputum induction bronchoscopy

suctioning +

Centers for Disease Control and Prevention (CDC) httpswwwcdcgovcoronavirus2019-ncovinfection-controlcontrol-recommendationshtml Advent Health (2020) Standard Operating Procedures (SOP) Personal Protective Equipment Guidance for Novel Respiratory Virus COVID-19

N95 Masks with Exhalation valves

bull These devices have exhalation valves that we recognize do not filter

the exhaled air of the person wearing the device

bull The devices (respirators) with exhalation valves fill a necessary supply

gap with N95s for AMITA amp Ascension

bull Both respirators have been approved for use by the Ascension National

Infection Control team

bull These respirators are to be covered with a medical facemask if wearing

the device for universal masking purposes andor around patients with

unknown COVID statusother associatesproviders

bull AMITA amp Ascension do not support these respirators being covered with

a surgical face mask for use in the Operating Room for multiple

reasons 1) CDC does not support 2) they are not FDA approved for

surgery and 3) 3M does not support3M 8511

3M 6000 series N100

elastomerics

7

N95 Masks with Exhalation valves

bull The Envo N95 mask is NOT approved for use

bull Next Steps

1 SBAR from Ascension

2 Update AMITA PPE playbook

3 Share this information in huddles team meetings

local command center calls etc

Envo N95 mask

8

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 3: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Chapter 1 Screening and Testing

3

Quick Screen IPDH Criteria to Evaluate Patients for COVID-19

Target Population for Evaluation ALL patients who present at an AMITA Emergency Department

AMITA is following the guidance of the Centers for Disease Control and prevention (CDC) forldquoCriteria to Guide Evaluation of PUI COVID-19rdquo at httpswwwcdcgovcoronavirus2019-nCoVhcpclinical-criteriahtml

Clinical Symptoms Epidemiologic Risks

Fever (ge1000) Cough Shortness of breath Loss of taste or smell

Sore throat

Myalgias (muscle pain) Headache

Chills

OR

Personal history of suspected or laboratory confirmedCOVID-19 within the last 14 days

Close contact with a person with suspected or laboratoryconfirmed COVID-19 within the last 14 days

Lives in assistive living or recently discharged from anursing homerehab facility known to have clusters ofinfluenza or COVID-19-like illness

IF patient answers YES to ANY Clinical Symptoms or Risk Factors

Patient at risk for COVID-19 like illness Triage patient appropriately

Physicians and APCs should Refer to ldquoTesting Decision Matrixrdquo as outlined by CDChttpswwwcdcgovcoronavirus2019-ncovsymptoms-testingtestinghtml

COVID-19 screening performed NEGATIVE for COVID-like illness Proceed with appointment

Updated 5120 Signature

4

Chapter 2 Personal Protective Equipment (PPE)

5

Guidelines for PPE August 7 2020

Adjustments in these guidelines are subject to changes in standards of care andor supply chain availability

Tier Situation PPE for Patient Care Activities

Tier 1 GreeterScreenerUniversal

Masking

Non PUICOVID-19 patient Standard precautions + universal masking

(follow isolation precautions if patients are on isolation for something other than COVID)

Tier 2 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

PUICOVID-19 not receiving aerosol generating

procedure (AGP) OR when collecting NP swab

Tier 3 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

ALL PATIENTSRegardless of COVID Status

receiving aerosol generating procedure (AGP)

AGP = Positive pressure ventilation (BiPAPCPAP) endotracheal intubation airway

suctioning high frequency oscillatory ventilation tracheostomy chest PT Nebulizer treatment sputum induction bronchoscopy

suctioning +

Centers for Disease Control and Prevention (CDC) httpswwwcdcgovcoronavirus2019-ncovinfection-controlcontrol-recommendationshtml Advent Health (2020) Standard Operating Procedures (SOP) Personal Protective Equipment Guidance for Novel Respiratory Virus COVID-19

N95 Masks with Exhalation valves

bull These devices have exhalation valves that we recognize do not filter

the exhaled air of the person wearing the device

bull The devices (respirators) with exhalation valves fill a necessary supply

gap with N95s for AMITA amp Ascension

bull Both respirators have been approved for use by the Ascension National

Infection Control team

bull These respirators are to be covered with a medical facemask if wearing

the device for universal masking purposes andor around patients with

unknown COVID statusother associatesproviders

bull AMITA amp Ascension do not support these respirators being covered with

a surgical face mask for use in the Operating Room for multiple

reasons 1) CDC does not support 2) they are not FDA approved for

surgery and 3) 3M does not support3M 8511

3M 6000 series N100

elastomerics

7

N95 Masks with Exhalation valves

bull The Envo N95 mask is NOT approved for use

bull Next Steps

1 SBAR from Ascension

2 Update AMITA PPE playbook

3 Share this information in huddles team meetings

local command center calls etc

Envo N95 mask

8

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 4: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Quick Screen IPDH Criteria to Evaluate Patients for COVID-19

Target Population for Evaluation ALL patients who present at an AMITA Emergency Department

AMITA is following the guidance of the Centers for Disease Control and prevention (CDC) forldquoCriteria to Guide Evaluation of PUI COVID-19rdquo at httpswwwcdcgovcoronavirus2019-nCoVhcpclinical-criteriahtml

Clinical Symptoms Epidemiologic Risks

Fever (ge1000) Cough Shortness of breath Loss of taste or smell

Sore throat

Myalgias (muscle pain) Headache

Chills

OR

Personal history of suspected or laboratory confirmedCOVID-19 within the last 14 days

Close contact with a person with suspected or laboratoryconfirmed COVID-19 within the last 14 days

Lives in assistive living or recently discharged from anursing homerehab facility known to have clusters ofinfluenza or COVID-19-like illness

IF patient answers YES to ANY Clinical Symptoms or Risk Factors

Patient at risk for COVID-19 like illness Triage patient appropriately

Physicians and APCs should Refer to ldquoTesting Decision Matrixrdquo as outlined by CDChttpswwwcdcgovcoronavirus2019-ncovsymptoms-testingtestinghtml

COVID-19 screening performed NEGATIVE for COVID-like illness Proceed with appointment

Updated 5120 Signature

4

Chapter 2 Personal Protective Equipment (PPE)

5

Guidelines for PPE August 7 2020

Adjustments in these guidelines are subject to changes in standards of care andor supply chain availability

Tier Situation PPE for Patient Care Activities

Tier 1 GreeterScreenerUniversal

Masking

Non PUICOVID-19 patient Standard precautions + universal masking

(follow isolation precautions if patients are on isolation for something other than COVID)

Tier 2 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

PUICOVID-19 not receiving aerosol generating

procedure (AGP) OR when collecting NP swab

Tier 3 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

ALL PATIENTSRegardless of COVID Status

receiving aerosol generating procedure (AGP)

AGP = Positive pressure ventilation (BiPAPCPAP) endotracheal intubation airway

suctioning high frequency oscillatory ventilation tracheostomy chest PT Nebulizer treatment sputum induction bronchoscopy

suctioning +

Centers for Disease Control and Prevention (CDC) httpswwwcdcgovcoronavirus2019-ncovinfection-controlcontrol-recommendationshtml Advent Health (2020) Standard Operating Procedures (SOP) Personal Protective Equipment Guidance for Novel Respiratory Virus COVID-19

N95 Masks with Exhalation valves

bull These devices have exhalation valves that we recognize do not filter

the exhaled air of the person wearing the device

bull The devices (respirators) with exhalation valves fill a necessary supply

gap with N95s for AMITA amp Ascension

bull Both respirators have been approved for use by the Ascension National

Infection Control team

bull These respirators are to be covered with a medical facemask if wearing

the device for universal masking purposes andor around patients with

unknown COVID statusother associatesproviders

bull AMITA amp Ascension do not support these respirators being covered with

a surgical face mask for use in the Operating Room for multiple

reasons 1) CDC does not support 2) they are not FDA approved for

surgery and 3) 3M does not support3M 8511

3M 6000 series N100

elastomerics

7

N95 Masks with Exhalation valves

bull The Envo N95 mask is NOT approved for use

bull Next Steps

1 SBAR from Ascension

2 Update AMITA PPE playbook

3 Share this information in huddles team meetings

local command center calls etc

Envo N95 mask

8

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 5: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Chapter 2 Personal Protective Equipment (PPE)

5

Guidelines for PPE August 7 2020

Adjustments in these guidelines are subject to changes in standards of care andor supply chain availability

Tier Situation PPE for Patient Care Activities

Tier 1 GreeterScreenerUniversal

Masking

Non PUICOVID-19 patient Standard precautions + universal masking

(follow isolation precautions if patients are on isolation for something other than COVID)

Tier 2 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

PUICOVID-19 not receiving aerosol generating

procedure (AGP) OR when collecting NP swab

Tier 3 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

ALL PATIENTSRegardless of COVID Status

receiving aerosol generating procedure (AGP)

AGP = Positive pressure ventilation (BiPAPCPAP) endotracheal intubation airway

suctioning high frequency oscillatory ventilation tracheostomy chest PT Nebulizer treatment sputum induction bronchoscopy

suctioning +

Centers for Disease Control and Prevention (CDC) httpswwwcdcgovcoronavirus2019-ncovinfection-controlcontrol-recommendationshtml Advent Health (2020) Standard Operating Procedures (SOP) Personal Protective Equipment Guidance for Novel Respiratory Virus COVID-19

N95 Masks with Exhalation valves

bull These devices have exhalation valves that we recognize do not filter

the exhaled air of the person wearing the device

bull The devices (respirators) with exhalation valves fill a necessary supply

gap with N95s for AMITA amp Ascension

bull Both respirators have been approved for use by the Ascension National

Infection Control team

bull These respirators are to be covered with a medical facemask if wearing

the device for universal masking purposes andor around patients with

unknown COVID statusother associatesproviders

bull AMITA amp Ascension do not support these respirators being covered with

a surgical face mask for use in the Operating Room for multiple

reasons 1) CDC does not support 2) they are not FDA approved for

surgery and 3) 3M does not support3M 8511

3M 6000 series N100

elastomerics

7

N95 Masks with Exhalation valves

bull The Envo N95 mask is NOT approved for use

bull Next Steps

1 SBAR from Ascension

2 Update AMITA PPE playbook

3 Share this information in huddles team meetings

local command center calls etc

Envo N95 mask

8

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 6: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Guidelines for PPE August 7 2020

Adjustments in these guidelines are subject to changes in standards of care andor supply chain availability

Tier Situation PPE for Patient Care Activities

Tier 1 GreeterScreenerUniversal

Masking

Non PUICOVID-19 patient Standard precautions + universal masking

(follow isolation precautions if patients are on isolation for something other than COVID)

Tier 2 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

PUICOVID-19 not receiving aerosol generating

procedure (AGP) OR when collecting NP swab

Tier 3 One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care

ALL PATIENTSRegardless of COVID Status

receiving aerosol generating procedure (AGP)

AGP = Positive pressure ventilation (BiPAPCPAP) endotracheal intubation airway

suctioning high frequency oscillatory ventilation tracheostomy chest PT Nebulizer treatment sputum induction bronchoscopy

suctioning +

Centers for Disease Control and Prevention (CDC) httpswwwcdcgovcoronavirus2019-ncovinfection-controlcontrol-recommendationshtml Advent Health (2020) Standard Operating Procedures (SOP) Personal Protective Equipment Guidance for Novel Respiratory Virus COVID-19

N95 Masks with Exhalation valves

bull These devices have exhalation valves that we recognize do not filter

the exhaled air of the person wearing the device

bull The devices (respirators) with exhalation valves fill a necessary supply

gap with N95s for AMITA amp Ascension

bull Both respirators have been approved for use by the Ascension National

Infection Control team

bull These respirators are to be covered with a medical facemask if wearing

the device for universal masking purposes andor around patients with

unknown COVID statusother associatesproviders

bull AMITA amp Ascension do not support these respirators being covered with

a surgical face mask for use in the Operating Room for multiple

reasons 1) CDC does not support 2) they are not FDA approved for

surgery and 3) 3M does not support3M 8511

3M 6000 series N100

elastomerics

7

N95 Masks with Exhalation valves

bull The Envo N95 mask is NOT approved for use

bull Next Steps

1 SBAR from Ascension

2 Update AMITA PPE playbook

3 Share this information in huddles team meetings

local command center calls etc

Envo N95 mask

8

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 7: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

N95 Masks with Exhalation valves

bull These devices have exhalation valves that we recognize do not filter

the exhaled air of the person wearing the device

bull The devices (respirators) with exhalation valves fill a necessary supply

gap with N95s for AMITA amp Ascension

bull Both respirators have been approved for use by the Ascension National

Infection Control team

bull These respirators are to be covered with a medical facemask if wearing

the device for universal masking purposes andor around patients with

unknown COVID statusother associatesproviders

bull AMITA amp Ascension do not support these respirators being covered with

a surgical face mask for use in the Operating Room for multiple

reasons 1) CDC does not support 2) they are not FDA approved for

surgery and 3) 3M does not support3M 8511

3M 6000 series N100

elastomerics

7

N95 Masks with Exhalation valves

bull The Envo N95 mask is NOT approved for use

bull Next Steps

1 SBAR from Ascension

2 Update AMITA PPE playbook

3 Share this information in huddles team meetings

local command center calls etc

Envo N95 mask

8

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 8: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

N95 Masks with Exhalation valves

bull The Envo N95 mask is NOT approved for use

bull Next Steps

1 SBAR from Ascension

2 Update AMITA PPE playbook

3 Share this information in huddles team meetings

local command center calls etc

Envo N95 mask

8

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 9: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Personal Protective Equipment (PPE) Conservation One (1) N95 mask per day will be provided to each direct caregiver in High Risk Areas ED ICU COVID units and other areas where COVIDPUI patients

receive care Adjustments are subject to change with changes in standards of care andor supply chain availability

SUPPLY ITEM WHEN HOW TO RE US E

N95 MASKS

N95 must be covered by a FULL face shield when providing

direct patient care for

Tier 2 and Tier 3 patients

bull When removing the N95

bull Perform hand hygiene

bull Don clean pair of gloves

bull Grasp straps and remove mask without touching the front or inside

bull Place in clean breathable container such as a labeled paper bag

bull Doff gloves and perform hand hygiene

bull Don a face mask as per universal masking protocol

bull If the seal check is performed on the mask and integrity is maintained the mask canbe worn multiple times otherwise the mask should be replaced immediately

bull If the N95 becomes damp damaged visibly soiled or hard to breathe through it mustbe discarded

NOTE N95 should be covered by a clean face mask for aerosolizing procedures and the facemask should be discarded upon exiting the room

FACE SHIELD

bull Must be disinfected inside and outside with hospital‐approved disinfectant wipe afterdoffing

bull If the hospital approved disinfectant wipe contains bleachbull Allow appropriate dwell timebull Rinse the shield or wipe with a wet paper towel taking care not to get the foam

headband wetbull Dry thoroughly

bull Label face shield and store in a clean location until damaged or unusable

bull Perform hand hygiene before and after contact 9

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 10: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Coronavirus Disease 2019 (COVID-19)

Summary Strategies to Optimize the Supply of PPEduring ShortagesUpdated July 16 2020 Print

This quick reference table summarizes CDCrsquos strategies to optimize personal protective equipment (PPE) supplies inhealthcare settings and provides links to CDCrsquos full guidance documents on optimizing supplies These strategies oer acontinuum of options using the framework of surge capacity when PPE supplies are stressed running low or absent Whenusing these strategies healthcare facilities should

Consider these options and implement them sequentially

Understand their current PPE inventory supply chain and utilization rate

Train healthcare personnel on PPE use and have them demonstrate competency with donning and dong any PPEensemble that is used to perform job responsibilities

As PPE availability returns to normal promptly resume standard practices

PPE Type Conventional Contingency Crisis

All PPE Use physical barriers and otherengineering controls

Limit number of patients going tohospital or outpatient settings

Use telemedicine whenever possible

Exclude all HCP not directly involved inpatient care

Limit face-to-face HCP encounters withpatients

Exclude visitors to patients with knownor suspected COVID-19

Cohort patients andor HCP

Selectively cancel elective and non-urgent procedures and appointmentsfor which PPE is typically used by HCP

Decrease length of hospital stay formedically stable patients with COVID-19

Cancel all elective and non-urgentprocedures and appointments forwhich PPE is typically used by HCP

10

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 11: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

PPE Type Conventional Contingency Crisis

N95Respirators

Implement just-in-time t testing

Limit respirators during training

Implement qualitative t testing

Use alternatives to N95 respiratorssuch as other ltering facepiecerespirators elastomeric respiratorsand powered air purifying respirators

Additional guidance

Temporarily suspend annual t testing

Use N95 respirators beyond themanufacturer-designated shelf life fortraining and t testing

Extend the use of N95 respirators bywearing the same N95 for repeatedclose contact encounters with severaldierent patients

Additional guidance on contingencycapacity strategies

Additional guidance on extended use

Use respirators beyond themanufacturer designated shelf life forhealthcare delivery

Use respirators approved understandards used in other countries

Implement limited re-use of N95respirators During times of crisis itmay be needed to practice limited re-use on top of extended use

Use additional respirators beyond themanufacturer-designated shelf lifethat have not been evaluated byNIOSH

Prioritize the use of N95 respiratorsand facemasks by activity

Additional guidance on crisis capacitystrategies

Additional guidance on re-use

Facemasks Use facemasks according to productlabeling and local state and federalrequirements

Additional guidance

Place facemasks in a secure andmonitored site

Provide facemasks to symptomaticpatients upon check-in at entry points

Implement extended use of facemasks

Restrict facemasks for use by HCPrather than asymptomatic patients(who might use cloth face coverings)for source control

Additional guidance

Use facemasks beyond themanufacturer-designated shelf lifeduring patient care activities

Implement limited re-use of facemasks

Prioritize facemasks for selectedactivities such as essential surgeriesactivities where splashes and spraysare anticipated prolonged face-to-facecontact with an infectious patient andaerosol-generating procedures

When no facemasks are available

Use a face shield that covers the entirefront (that extends to the chin orbelow) and sides of the face with nofacemask

Additional guidance

Gowns Use isolation gown alternatives thatoer equivalent or higher protection

Additional guidance

Shift gown use toward cloth isolationgowns

Consider the use of coveralls

Use gowns beyond the manufacturer-designated shelf life for training

Use gowns or coveralls conforming tointernational standards

Additional guidance

Extend the use of isolation gowns

Re-use cloth isolation gowns

Prioritize gowns for activities wheresplashes and sprays are anticipatedand during high-contact patient care

When no gowns are available

Consider using gown alternatives thathave not been evaluated as eective

Additional guidance

EyeProtection

Use eye protection according toproduct labeling and local state andfederal requirements

Additional guidance

Shift eye protection supplies fromdisposable to re-usable devices

Extend the use of eye protection

Additional guidance

Use eye protection devices beyond themanufacturer-designated shelf life

Prioritize eye protection for activitieswhere splashes and sprays areanticipated or prolonged face-to-faceor close contact is unavoidable

Consider using safety glasses thatcover the sides of eyes

Additional guidance

11

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 12: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

PPE Type Conventional Contingency Crisis

Gloves Continue providing patient care as inusual infection control practice

Additional guidance

Use gloves past their manufacturer-designated shelf life for trainingactivities

Use gloves conforming to other USand international standards

Additional guidance

Use gloves past their manufacturer-designated shelf life for healthcaredelivery

Prioritize the use of non-steriledisposable gloves

Consider non-healthcare glovealternatives

Extend the use of disposable medicalgloves

Additional guidance

Page last reviewed July 16 2020

12

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 13: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

How To Perform a Particulate Respirator Seal Check Adapted from Epidemic and Pandemic Alert and Response | World Health Organization 2008

Step 1 minus Perform appropriate hand hygiene and don gloves minus Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang

freely below your hand

Step 2

minus Position the respirator under your chin with the nosepiece up

Step 3

minus Pull the top strap over your head resting it high at the back of your head Pull the bottom strap over your

head and position it around the neck below the ears

Step 4

minus Place fingertips of both hands at the top of the metal nosepiece Mold the nosepiece (USING TWO FINGERS OF

EACH HAND) to the shape of your nose Pinching the nosepiece using one hand may result in less effective respirator performance

Step 5

minus Cover the front of the respirator with both hands being careful not to disturb the position of the respirator

Step 5a Positive seal check minus Exhale sharply A positive pressure inside the respirator = no leakage If leakage adjust the position andor

tension straps Retest the seal Repeat the steps until the respirator is secured properly Step 5b Negative seal check minus Inhale deeply If no leakage negative pressure will make respirator cling to your face minus Leakage will result in loss of negative pressure in the respirator due to air entering through gaps in the seal minus Doff gloves and perform appropriate hand hygiene

13

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 14: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

N95 RESPIRATOR PRODUCT UPDATE

In order to ensure protection and prevent a

disruption in product availability AMITA Health is

implementing the use of additional models of N95

respirators

In addition a full face shield must always be used

when wearing any N95 respirator per the AMITA

Health COVID-19 Infection Prevention ndash Acute Care

playbook

More information on COVID-19 playbooks and resources

can be found at

httpswwwamitahealthorgcovid-19-amita

14

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 15: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

AMITA Healthrsquos facilities have previously used the following models of N95s

Brand Model Photo

3M 1860

1860S

1870+

Halyard 46727

46827

AMITA Healthrsquos facilities will begin fit-testing and distributing the following models of N95s

Brand Model Photo

3M 8511

8210

Gerson 2140

For any questions please connect directly with your local Resource Group Operations Manager and

Critical Products Manager

15

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 16: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Personal Protective Equipment (PPE) Validation Checklist During care of the patient with known or suspected COVID-19

Personal Protective Equipment (PPE) ValidationStaff Training Overview

Purpose

To create a consistent process of monitoring Donning and Doffing of PPE consistent

with CDC recommendations

Refer to Appendix C for the PPE Validation Self-Check Attestation

Refer to Appendix D for the PPE Validation Checklist for Monitor Observing

Expectations

bull Form Overview and Associate actions

Appendix C Personal Protective Equipment (PPE) Validation Self-Check Attestation

o Staff assigned to care for patient suspected or confirmed with COVID-19

o Reviews proper PPE donning and doffing expectations

o Attests that they will report any PPE needs for Ante Room

o Attests that they will report any PPE suspected of malfunctioningo Understands that they may be monitored for proper

donning and doffing

o Signs that they understand the importance of consistent

PPE compliance

o Files completed form in employee file

Appendix D Personal Protective Equipment (PPE) Validation Checklist (for Monitors observing)

Each individual entering patient room if suspected or confirmed COVID-19 will be

monitored for safe donning and doffing practices The assigned PPE Monitor will

OBSERVE and VALIDATE every time

o Proper PPE application

o Proper Date and Room number

o Consistent time entries for EACH time individual enters the room and exitso Assigned PPE Monitor and ALL Caregivers to enter Role Printed Name and

Signature

o Monitor to print name and relationship if visitor

o Forward to charge nurse Infection Control will pick upo Note multiple sheets may be required each day based on individuals entering the

room

o Note MUST remind individuals that doffing may require self-monitoring if AnteRoom DOES NOT have a window Do NOT open doors for these doffingobservations

o Both the HCP providing care and the monitor will document PPE use and

hand hygiene for both donning and doffing

bull Appendix E PUI Isolation Sign-InOut Sheet

bull Appendix F Infection PreventionLeader Rounding Checklist

16

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 17: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Important Update Regarding Air Pressure in OrsProcedural Areas

1) All Operating Rooms and procedure rooms (including Cath Lab and IR) need to maintain

a positive pressure relationship to the adjacent areas Altering the airflow in these areas

compromises the sterile environment and puts healthcare workers at greater risk of

exposure

2) NEVER put an N95 mask on a patient Patients should be transported with a procedural

mask

3) Proper room cleaning should be as follows

Terminal clean of an ORprocedure space

a If an aerosol generating procedure was not performed

bull Procedure room may be cleaned immediately

bull Contact EVS and request a COVID-19 terminal clean

b If an aerosol generating procedure was performed

bull Close procedure room and do not allow anyone to enter the space

for 1 hour

bull After one hour has passed contact EVS and request a COVID-19

terminal clean

Reference

American Society of Healthcare Engineering (ASHE)American Hospital Association

(AHA) Facility Guidelines

From the ASHE Website

17

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 18: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Transporting of PUI or Confirmed COVID 19 patients Within a Health Care Facility

What personal protective equipment (PPE) should be worn by individuals transporting

patients who are confirmed with or under investigation for COVID-19 within a healthcare

facility For example what PPE should be worn when transporting a patient to radiology

for imaging that cannot be performed in the patient room

In general transport and movement of the patient outside of their room should be limited to medically essential purposes If being transported outside of the room such as to radiology healthcare personnel (HCP) in the receiving area should be notified in advance of transporting the patient For transport the patient should wear a facemask to contain secretions and be covered with a clean sheet

If transport personnel must prepare the patient for transport (eg transfer them to the wheelchair or gurney) transport personnel should wear all recommended PPE (gloves a gown respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator or facemaskmdashif a respirator is not availablemdashand eye protection [ie goggles or disposable face shield that covers the front and sides of the face]) This recommendation is needed because these interactions typically involve close often face-to-face contact with the patient in an enclosed space (eg patient room) Once the patient has been transferred to the wheelchair or gurney (and prior to exiting the room) transporters should remove their gown gloves and eye protection and perform hand hygiene

If the patient is wearing a facemask no recommendation for PPE is made typically for HCP transporting patients with a respiratory infection from the patientrsquos room to the destination However given current limitations in knowledge regarding COVID-19 and following the currently cautious approach for risk stratification and monitoring of healthcare personnel caring for patients with COVID-19 use of a facemask by the transporter is recommended for anything more than brief encounters with COVID-19 patients Additional PPE should not be required unless there is an anticipated need to provide medical assistance during transport (eg helping the patient replace a dislodged facemask)

After arrival at their destination receiving personnel (eg in radiology) and the transporter (if assisting with transfer) should perform hand hygiene and wear all recommended PPE If still wearing their original respirator or facemask the transporter should take care to avoid self- contamination when donning the remainder of the recommended PPE This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States

Interim guidance for EMS personnel transporting patients with confirmed or suspected COVID-19 is available here EMS personnel should wear all recommended PPE because they are providing direct medical care and in close contact with the patient for longer periods of time Reference httpswwwcdcgovcoronavirus2019-ncovinfection-controlinfection- prevention-control-faqhtml

18

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 19: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Chapter 3 Cleaning

19

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 20: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

During this COVID-19 crisis please be aware that you may see a variety of disinfectantswipes for use against COVID-19 The below products are listed on the EPAs website for approved disinfectants against COVID-19 Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product Products noted for killing C diff spores are noted these products will also disinfectant against COVID-19Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors Spraydisinfectant will need to be sprayed on a wiperag before wiping down equipment of any kind to prevent damage andormalfunction

Image of the Product Product Name and number Company Name Contact Time (In Minutes)

Sani-Cloth XLarge 55 Alcohol Q86984

GRAINGER - 9JAJ1 (1) 172H69 (6pk)

Super Sani Large 55 Alcohol Q55172

GRAINGER - 9RYJ7 (1)

Professional Disposables

International

2 minutes

Sani-Cloth Bleach Germicidal PDI P54072 P25784 P7007P P700RF H58195

U26595

GRAINGER - 16Z989

Professional Disposables

International

4 minutes

kills C Diffspores in 4

minutes

Sani-Cloth AF3 Large Canister P13872

Sani-Cloth AF3 Germicidal Wipes XL 81626514

Professional Disposables

International

Performance Health

3 minutes

SaniPrime (RTU-Wipes)

P25372 P24284 H06182 amp U13195

Professional Disposables

International

1 minute

20

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 21: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Caviwipe1 XL 65 WipesCanister 13-5150

GRAINGER - 6TWF8 - 13-1150

Caviwipe1 Regular 160 WipesCanister 13-5100

Metrex For the coronavirus this

wipe does in fact need a 3-

minute kill time All other

pathogens require a 1

minute But only the

Coronavirus or in this case the

Adenovirus (most similar) is going to require

the use of 3-minute kill time

Caviwipe Bleach 6X10 90 WipesCanister 13-9100

Metrex 3 minutes

kills C Diffspores in 3

minutes

Cavicide (RTU)

GRAINGER - 3VDJ1 (24oz Bottle) 3VDJ2 (1gal Bottle) 3VDJ3 (25 Gal Bottle) 3VDJ7 (25 Gal

Easy Pour Jug)

Metrex 3 minutes

Clorox Healthcarereg Bleach Germicidal Wipes Office Depot 439675 1630225 265701

825962 8373413 764946 129202 8193323 8193614 8193080

Medline CLO30358H CLO35309 CLO31424Z CLO31424 CLO30577H CLO30577

GRAINGER 1XEZ3 4XKR8 4XKR7 6VDE9

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

kills C diff spores

21

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 22: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Clorox Healthcarereg Hydrogen Peroxide Cleaner Disinfectant Wipes

Medline CLO30827 CLO30826Z CLO30826 CLO30825Z CLO30825 CLO30824H

GRAINGER 401Z41 401Z45 401Z42 401Z40

Clorox Professional Products Company

2 minutes

Healthcare Fuzion Cleaner (Spray)

GRAINGER 52LC52

Clorox Professional Products Company

1 minute

Oxivir Tb

GRAINGER 5KRJ0 (32oz Trigger Spray RTU 12PK) 48TJ10

(RTU 1 gal jug 4PK) 5KRJ1 (TB Wipes)

Diversey Inc 1 minute

Oxivir 1 (RTU-Wipe) GRAINGER

53JX16 (Wipes 6rdquox7rdquo) 53JX15 (Wipes 7rdquox8rdquo) 53JX17 (Wipes Bucket 11rdquox12rdquo) 45DW77

(Wipes Refill)

53JX14 (32oz Bottle RTU 12PK)

Diversey Inc 1minute

Oxivir Five 16 (Concentrate-Dip and use method)

GRAINGER 11Y608 (RTU 1 Gal Jug) 11Y610 (J-Fill Chem Dispenser) 15V142 (15 Gal Jug RTU

2pk) 11Y607 (RTD Chem Dispenser PK) 11Y609 (SmartDose Chem Dispenser)

Diversey Inc 5 minutes

22

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 23: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Avert Sporicidal (RTU-wipe)

Diversey Inc 1 minute

kills C Diffspores in 4

minutes

Virex II 256 (Concentrate-Dip and use method)

GRAINGER 11W407 (1 Gal Jug) 10A336 (15 Gal Jug 2pk) 10C417 (J-Fill Chem Dispenser 2PK) 11Y654 (RTD Chem Dispenser) 6EFY2 (SmartDose Chem Dispenser) 11Y653 (32oz

Concentrated)

Diversey Inc 10 minutes

Virex Plus (Concentrate must be at 1128-Dip and Use

Method)

Diversey Inc 5 minutes

Noroxycdiff (electrostatic spray application)

Pervasive 7 minutes-15 minutes post

discharge clean process time

Dispatch 69150

GRAINGER 22D022

Clorox Professional Products Company

1 minute

Pericept (Concentrate-Dip and use method)

SSS 2 minutes

kills C Diffspores in 4minutes-

contains nobleach or alcohol

23

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 24: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Side Kick Disinfecting Wipes Standard Wipes Model Number 2060-000-001

Large Wipes Model Number 2060-000-002

Stryker 2 minutes

Maxim GSC Germicidal Spray Cleaner Product Number 042000

Midlab 2 minutes

Clorox Commercial Solutionsreg Cloroxreg Disinfecting Wipes Product 15949

Clorox Professional Products Company

4 minutes

Opti-Cide 3reg Wipes Item OCW06-100

Micro-Scientific LLC 3 minutes

24

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 25: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Opti-Cide 3 Item OCS12-024

Micro-Scientific LLC 2 minutes

Opti-Cide 3 Item OCP04-128

Micro-Scientific LLC 2 minutes

Clorox Healthcarereg Bleach Germicidal Trigger Spray Bottle

Grainger Mfr Model 68970 Catalog Page 1512

Clorox Professional Products Company

3 minutes

kills C Diffspores in 3

minutes

Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 secondapplications are required Please

wipe down surfaces allow a 30 second dwell

time for cleansing then

please wipe down surface again allow a

30 second dwell time for

disinfection

25

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 26: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 secondapplications are required Please spray surfaces

allow a 30 second dwell

time for cleansing then

please spray surface again

allow a 30 second dwell

time for disinfection

Ecolab Quaternary Disinfectant Wipes

12 x 85 XL Wipes 6000169 12x220 Wipes 6000166

Ecolab 2 minutes

26

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 27: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

These approved disinfectants are being utilized frequently during this time of COVID-19 However

please be aware that in the coming months we stay mindful of expiration dates regarding these

products Many of these approved disinfectants use a coding system of a Julian date code for their

expiration An example of this coding is listed below for reference

27

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 28: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

At AMITA Health Touchpoint is responsible for cleaning the rooms for PUIs and confirmed COVID 19 cases Any concerns related to cleaning of rooms or lack there of please contact Touchpoint services

Environmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings including those patient-care areas in which aerosol-generating procedures are performed Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2 Management of laundry food service utensils and medical waste should also be performed in accordance with routine procedures

Reference httpswwwcdcgovcoronavirus2019-ncovhcpcaring-for-patientshtml

28

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 29: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Chapter 4 Clinical Protocols

29

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 30: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

COVID Awake RepositioningProning Protocol (CARP)

30

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 31: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

31

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 32: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Instructions for patients with cough or trouble breathing

32

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 33: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Respiratory support guideline for COVID-19 (PUI or confirmed) patients

33

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 34: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

34

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 35: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

35

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 36: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

36

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 37: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Chapter 5 Pressure Injury Prevention

in COVID-19

37

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 38: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Protecting Facial Skin Under PPE N95 Face Masks

38

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 39: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Guidelines for N95 Masks ndash Preventing Facial Pressure Injury

Three factors we can influence to prevent these injuries

bull Intensity of pressure (and shear)

bull Duration of pressure (and shear)

bull Tissue tolerance of the individual

N95 Masks

bull Require a tight seal that should be seal-checked by the user each time it is

donned

bull Anything placed between the skin and mask should not interfere with the

function of the mask

bull There is currently no evidence to ensure the wearersrsquo safety from viral

penetration when a wound care dressing is placed under a respirator mask

Goal Present injury from friction moisture and pressure

bull Application of a liquid skin sealantprotectant on skin surfaces that will be in

contact with the mask may help prevent friction injuries and will not interfere

with the fit of the N95 mask

bull Do not use petroleum jelly mineral oil or any other compound that could

enhance slippage

bull Remove the mask from your face for 15 minutes every 2 hours outside of areas

of patient contact

bull Treat abrasions with topical moisturizers liquid skin protectantsealant thin

occlusive dressings may be used to protect open wounds if they do not interfere

with the mask seal Deep tissue injuries stage 3 or 4 and unstageable wounds

should be referred for professional wound care

(For further directioninformation contact your wound care nurse)

Reference NPIAP Position Statements on Preventing Injury with N95 Masks 2020

39

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 40: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Pressure Injury Prevention PIP Tips for Prone Positioning

40

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 41: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

41

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 42: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

42

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 43: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Chapter 6 Discharge Instructions

43

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 44: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

FAQs for Patients

Q What is 2019 Novel Coronavirus (COVID-19)

A There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses COVID-19 is a new disease caused by a novel (or new) coronavirus not previously seen in humans COVID-19 was identified as the cause of an outbreak of respiratory illness first detected in Wuhan China that has spread around the world including the United States and all 50 states

Q What are the symptoms of COVID-2019

A People who are infected with COVID-19 have developed mild to severe respiratory illness with symptoms including fever cough shortness of breath and potentially respiratory distress 2-14 days after exposure Call your health care provider for medical advice if you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or difficulty breathing

Q How does COVID-19 spread

A Coronaviruses are generally spread from person- to- person through respiratory droplets Someone who is actively sick with COVID-19 can spread the illness to others That is why CDC recommends that these patients be isolated from other family members Currently there is no evidence to support transmission of COVID ndash 19 associated with food It can be possible that a person can get COVID ndash 19 by touching a surface or object that has the virus on it and then touching their own mouth nose or possible their eyes

Q Who is at higher risk

People 65 years and older People at any age with Chronic lung disease or asthma Heart disease Diabetes Cancer patients or with weakened immune system

Q What are the treatments for COVID-19

A Currently there are no medicine to treat illnesses caused by COVID-19 Medical care is supportive to help relieve symptoms such as Tylenol for fever plenty of rest and fluids

44

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 45: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Q How can I help protect myself

bull Stay home as much as possible Restrict activities outside your home except for getting medical careAvoid public transportation and public areas Avoid crowds Avoid non- essential travel

bull Take everyday precautions to keep space between yourself and others

bull To the extent possible avoid touching high-touch surfaces in public places ndash elevator buttonsdoor handles handrails handshaking with people etc Use a tissue or your sleeve to cover your handor finger if you must touch something

bull Wash your hands after touching surfaces in public places

bull Avoid touching your face nose eyes etc

bull Clean and disinfect your home to remove germs practice routine cleaning of frequently touchedsurfaces (for example tables doorknobs light switches handles desks toilets faucets sinks amp cellphones)

bull Perform hand hygiene frequently Wash your hands with soap and water for 20 seconds or use analcohol-based hand sanitizer

bull Make sure that shared spaces at home have good air flow such as by air conditioner or an openedwindow weather permitting

Q What steps should I take if I am sick A If you think you have been exposed to COVID-19 and develop a fever and symptoms such as cough or

difficulty breathing call your healthcare provider for medical advice or call the COVID-19 hotline at Illinois Department of Public Health 1-800-889-3931

QHow long do I self-quarantine A If you have been diagnosed with COVID-19 you must quarantine yourself for 14 days after symptom onset If you have been in close contact with someone diagnosed with COVID-19 you must quarantine for 14 days since you first had contact with that person

For more information wwwcdcgovCOVID19

bull Pay attention for potential COVID-19 symptoms including fever cough and shortness ofbreath If you feel like you are developing symptoms call your doctor

bull If you develop emergency warning signs for COVID-19 get medical attentionimmediately In adults emergency warning signs

o Difficulty breathing or shortness of breatho Persistent pain or pressure in the chesto New confusion or inability to arouse

o Bluish lips or face

45

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 46: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Home Isolation Instructions for People with Coronavirus-2019 (COVID-19) Infection and

People Awaiting COVID-19 Test Results

The following instructions are for people who are infected with COVID-19 or who are waiting to

find out the result of their test It also includes information for their families or caregivers

Instructions for People Who Have or Who May Have COVID-19

1 Stay home Do not leave your home except to get medical care Do not go to workschool or public areas and do not use public transportation or taxis If someone deliversfood or other necessities ask them to leave them at your door if possible If you needto meet someone at your door wear a mask

2 Separate yourself from other people in your home As much as possible stay in adifferent room from other people in your home Use a separate bathroom if possibleIf you must be in the same room as other people wear a facemask to prevent spreadinggerms to others

3 Before you visit your doctor let them know Call ahead before visiting your doctor sothey can prepare for your visit and know that you have or may have COVID-19

4 Cover coughs and sneezes To prevent spreading germs to others when coughing orsneezing cover your mouth and nose with a tissue or your sleeve Throw used tissuesin a lined trash can and immediately wash hands with soap and water

5 Keep hands clean Wash hands often and thoroughly especially after blowing yournose coughing or sneezing going to the bathroom and before eating or preparingfood Use soap and water for at least 20 seconds Use hand sanitizer with at least 60alcohol if soap and water are not available and if your hands are not visibly dirty Avoidtouching your eyes nose and mouth with unclean hands

6 Avoid sharing household items Do not share dishes drinking glasses cups eatingutensils towels bedding or other items with other people in the home These itemsshould be washed thoroughly after use with soap and warm water

7 Monitor illness If your illness gets worse seek medical care Call ahead and tell themthat you have or may have COVID-19 If you have life-threatening symptoms (for exampletrouble breathing pain in chest) call 911 and tell them you have or may have COVID-19

Follow these recommendations

bull People with known COVID-19 infection until 14 days after symptom onset or 3 days

after fever resolution and significant symptom improvement whichever is longer

bull People waiting to learn if they are infected until you receive a negative COVID-19

test result

46

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 47: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Information for Caregivers Intimate Partners and Household

Members of People Who Have or May Have COVID-19

People who live with are intimate partners or provide home care for the

patient at home should

1 Be informed Make sure that you understand and can help the patient follow their

healthcare providerrsquos instructions for medication(s) and care

2 Limit visitors to only people caring for the patientbull As much as possible anyone who is not caring for the patient should stay in another

home or stay in other rooms They should also use a separate bathroom if possible

bull Keep elderly people and those who have weak immune systems or chronic healthconditions away from the person This includes people with diabetes chronic heartlung or kidney conditions

3 Make sure that shared spaces in the home have good air flow Open windows or

use an air conditioner if possible

4 Wash hands People in the home should wash their hands often and thoroughly with

soap and water for at least 20 seconds especially before eating or after using thebathroom Use an alcohol-based hand sanitizer if soap and water are not available and ifyour hands are not visibly dirty Avoid touching your eyes nose and mouth with uncleanhands

5 Wear disposable facemask and gloves when you touch or have contact with the

patientrsquos blood body fluids andor secretions (such as sweat saliva sputum nasalmucus vomit urine or diarrhea) When removing first remove and dispose of glovesThen immediately clean your hands with soap and water or alcohol-based hand sanitizerNext remove and dispose of facemask and immediately clean your hands again withsoap and water or alcohol-based hand sanitizer Do not reuse

6 Avoid sharing household items Do not share dishes drinking glasses cups eating

utensils towels bedding or other items with the patient Follow the cleaninginstructions below

7 Clean all ldquohigh-touchrdquo surfaces such as counters tabletops doorknobs bathroom

fixtures toilets phones keyboards tablets and bedside tables every day usinghousehold disinfectants Also clean any surfaces that may have blood body fluids andorsecretions or excretions on them

47

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 48: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Cleaning Instructions

bull Follow the recommendations provided on cleaning product labels including

precautions you should take when applying the product such as wearing gloves or

aprons and making sure you have good ventilation during use of the product

bull Use a diluted bleach solution or a household disinfectant with a label that says

ldquoEPA-approvedrdquo To find out if the product works against viruses read the product

label call the 1-800 number on the label or visit wwwepagov To make a bleach

solution at home add 1 tablespoon of bleach to 1 quart (4 cups) of water For a

larger supply add frac14 cup of bleach to 1 gallon (16 cups) of water

bull Wash laundry thoroughly

bull Immediately remove and wash clothes or bedding that have blood body fluids

andor secretions or excretions on them

bull Wear disposable gloves while handling soiled items Wash your hands immediately

after removing your gloves

bull Read and follow directions on labels of laundry or clothing items and detergent In

general wash and dry with the warmest temperatures recommended on the

clothing label

bull Place all used disposable gloves gowns facemasks and other contaminated items

in a lined container before disposing them with other household waste Wash your

hands immediately after handling these items

8 Monitor the patientrsquos illness If they are getting sicker call their medical provider

and tell the medical staff that the person has or is being evaluated for COVID-19 This

will help the healthcare providerrsquos office take steps to keep other people from getting

infected

It is important to note that caregivers household members and intimate partners

who do not follow these instructions when in close contact with the patient may

be considered to be ldquoclose contactsrdquo and should monitor their health Below is

information for close contacts

48

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 49: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Information for Close Contacts of People Who Have or May Have COVID-19

If you have had close contact with someone who is confirmed to

have or being evaluated for COVID-19 you should

Monitor your health Start from the day you first had close contact

with the patient and continue for 14 days after you last had close

contact with the person Watch for these signs and symptoms

bull Fever Take your temperature twice a day

bull Coughing

bull Shortness of breath or trouble breathing

bull Other early symptoms to watch for are chills body aches sore

throat headache diarrhea nauseavomiting and runny nose

If you develop fever or any of these symptoms call your healthcare

provider right away and let them know about being a close contact to a

patient with confirmed or suspected COVID-19 Stay home from school

work and other public spaces until your symptoms improve Refer to home

care instructions for further information

For more information visit httpdphillinoisgovtopics-servicesdiseases-and- conditionsdiseases-a-z-listcoronavirus

Fever Cough Trouble breathing

49

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 50: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

CDC Guidelines What to do if you are sick with Coronavirus disease 2019 (COVID-19)

50

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 51: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

CDC Home Care Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus

(COVID-19)

This interim guidance is for staff at local and state health departments infection

prevention and control professionals healthcare providers and healthcare

workers who are coordinating the home care and isolation of people who are

confirmed to have or are being evaluated for 2019 novel coronavirus (COVID-

19) infection (see Criteria to Guide Evaluation of Patients Under Investigation

(PUI) for COVID-19) This document does not apply to patients in healthcare

settings

For interim healthcare infection prevention and control recommendations (see

Interim Healthcare Infection Prevention and Control Recommendations) CDC

will update this interim guidance as needed and as more information becomes

available

Preventing COVID-19 from Spreading in Homes and Communities Interim

guidance that may help prevent COVID-19from spreading among people in

homes and in communities

Based on public health and medical evaluation some people who are confirmed

to have or being evaluated for COVID-19 infection and do not require

hospitalization for medical reasons may be cared for at home Prior to a

healthcare facility releasing a person to home care the following steps should

be taken

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff a healthcare

professional should assess whether the residential setting is suitable and

appropriate for home care assess whether the patient is capable of adhering to

precautions that will be recommended as part of home care or isolation

(respiratory hygiene hand hygiene etc) and notify their local or state health

department that the residential setting has been determined to be suitable for

home care and that hospital discharge is planned

51

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 52: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should provide CDCrsquos interim guidance for Preventing

COVID-19 from Spreading to Others in Homes and Communities to the person

confirmed to have or being evaluated for COVID-19 infection and to the

caregiver and household members and

contact their state or local health department to discuss criteria for discontinuing

any such measures

Footnotes

Isolation is defined as the separation or restriction of activities of an ill person

with a contagious disease from those who are well

Additional Resources

Interim Healthcare Infection Prevention and Control Recommendations for

Patients Under Investigation for 2019 Novel Coronavirus

Interim Guidance for Preventing 2019 Novel Coronavirus (2019-nCoV) from

Spreading to Others in Homes and Communities

52

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 53: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

March 25 2020

Expectations for Superior Ambulance Personnel Transporting COVID‐19 Patients

Dear Customers

During this challenging event Superior Ambulance strives to make transportation of COVID‐19

patients as seamless as possible Superior will continue to transport COVID‐19 patients by air or

ground without restrictions We understand the supply constraints facing all healthcare

operations and have issued new PPE guidance to our crews to help preserve PPE Please expect

the following actions from our personnel

COVID‐19 PPE Standards for EMS

Standard Contact and Droplet Precautions (Gloves Gown Surgical Mask Eye Protection) Surgical mask also placed on the patientUsed for most COVID‐19 patients

Add Airborne Precautions (N95 Mask) Used for high acuitycritically ill COVID‐19 patients o All ventedintubated patientso All patients on CPAP BIPAP or High Flow therapieso All patients undergoing nebulizer treatmentso During other aerosol‐generating procedures such as

intubation open suctioning or manual bagging

AT THE PICKUP FACILITY

bull Our personnel will request limited PPE to include gloves gowns and surgical

masks Our personnel will remove or change most PPE prior to traveling through

the hospital to prevent cross‐contamination

bull Our personnel will supply their own eye protection and N95 masks if needed Our

personnel will reuse these items on a limited basis

bull Our personnel will request belongings to be placed in a new belongings bag Our

personnel will disinfect the outside of the bag Please attempt to limit belongings and

wait to bag them until our arrival

DURING TRANSPORT

bull Our personnel will follow COVID‐19 treatment protocols during transport to minimize risk ofexposure

AT THE RECEIVING FACILITY

bull Our personnel will request 11 exchange of PPE supplies used during transport if

those items must be discarded (eg soiled gowns and masks or N95 masks

exceeding 5 uses)

bull Our personnel perform decontamination following every transport and will

perform an extensive decontamination after any COVID‐19 transport

This is a dynamic event We will continue to adapt our procedures as supply lines improve

and new guidance is issued from the CDC State and our EMS Medical Directors We will keep

you informed of significant changes and will continue to investigate and respond to all reports

of personnel not meeting these expectations

Thank you Mary Franco VP Superior Air‐Ground Ambulance Service

53

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 54: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

54

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 55: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Chapter 7 Removing Isolation Precautions

on COVID-19 Patients

55

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 56: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Recommendations for Removing Isolation Precautions on COVID-19 Positive Patients Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy This update incorporates recent evidence to inform the duration of isolation and precautions recommended to prevent transmission of SARS-CoV-2 to others while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources

Hospitalized Recommendations 1 Duration of isolation and precautions

o For most persons with COVID-19 illness isolation and precautions can generally be discontinued 10 daysafter symptom onset1 and resolution of fever for at least 24 hours without the use of fever-reducingmedications and with improvement of other symptoms

A limited number of persons with severe illness may produce replication-competent virusbeyond 10 days that may warrant extending duration of isolation and precautions for up to 20days after symptom onset consider consultation with infection control experts

o For persons who never develop symptoms isolation and other precautions can be discontinued 10 daysafter the date of their first positive RT-PCR test for SARS-CoV-2 RNA

2 Role of PCR testing2 to discontinue isolation or precautionso For persons who are severely immunocompromised a test-based strategy could be considered in

consultation with infectious diseases expertso For all others a test-based strategy is no longer recommended except to discontinue isolation or

precautions earlier than would occur under the strategy outlined in Part 1 above3 Role of PCR testing2 after discontinuation of isolation or precautions

o For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic afterrecovery retesting is not recommended within 3 months after the date of symptom onset for the initialCOVID-19 infection In addition quarantine is not recommended in the event of close contact with aninfected person

o For persons who develop new symptoms consistent with COVID-19 during the 3 months after the dateof initial symptom onset if an alternative etiology cannot be identified by a provider then the personmay warrant retesting consultation with infectious disease or infection control experts isrecommended Quarantine may be considered during this evaluation based on consultation with aninfection control expert especially in the event symptoms develop within 14 days after close contactwith an infected person

o For persons who never developed symptoms the date of first positive RT-PCR test for SARS-CoV-2 RNAshould be used in place of the date of symptom onset

4 Role of serologic testingo Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or

reinfectionAdditional information can be found at httpswwwcdcgovcoronavirus2019-ncovhcpduration-isolationhtml [1] Symptom onset is defined as the date on which symptoms first began including non-respiratory symptoms [2] PCR testing is defined as the use of an RT-PCR assay to detect the presence of SARS-CoV-2 RNA

Outpatient Recommendations (Please follow Re-Emergence Surgery Playbook for surgeries)

Symptomatic Utilize the Symptom based strategy recommended by CDC

1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (eg cough shortness of breath) and 2) At least 10 days have passed since symptoms first appeared Asymptomatic At least 10 days have passed since positive test result

Asymptomatic At least 10 days have passed since positive test result

56

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 57: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

I m po r

Chapter 8 Mortuary Care

57

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 58: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Postmortem Checklist for Suspected or Confirmed COVID-19 Patients

INSTRUCTIONS Upon completion of the checklist below (where applicable) use the reverse side as a label

for the body bag Check the appropriate box and secure this label to the bag prior to transportation

Supplies Needed Body Bag (Request from Supply Department or as normally obtained) New sling (for transfer of body bag to gurney) Disposable nitrile gloves (wear when handling the body bag)

In the Patient Room 1048576 Don COVID-19 PPE to prepare the body for transport to the morgue

1048576 Remove invasive lines and devices from the patient (unless required for Medical Examiner or Coroner review)

1048576 Pack and bandage wounds and natural openings with absorbent material to contain body fluids 1048576 Place tag on the patientrsquos toe labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo

ldquoCOVID-19 Test Pendingrdquo or DOA-no Covid-19 testing performed (Emergency Dept) 1048576 Place patient in the body bag and close (If patient body habitus will not allow

a standard sized bag to close completely request extra-large body bag) Double bag if using white bags Single bag for orange and black bags

1048576 Place tag on the body bag labeled ldquoCOVID-19 Positiverdquo ldquoCOVID-19 Negativerdquo ldquoCOVID-19 Test Pendingrdquo or ldquoDOA-no Covid-19 testing performedrdquo (Emergency Dept)

1048576 Place a sling under the body bag for transfer to the gurney 1048576 Move patient to gurney 1048576 Disinfect the outer surface of the body bag with an AMITA-approved disinfectant 1048576 Disinfect the handles of gurney for transportation with an AMITA-approved disinfectant 1048576 Doff Covid-19 PPE in accordance with doffing checklist 1048576 Perform hand hygiene 1048576 Follow discharge cleaning and room closure procedure

Transportation 1048576 Transportation will not enter the room gurney will be brought to hall for transport

Morgue 1048576 Using Standard Precautions move patient into cooler 1048576 Disinfect the gurney with AMITA-approved disinfectant 1048576 Perform Hand Hygiene 1048576 Decedents with Pending test results-hold the body in the morgue until Covid-19 test results

are available Cook County ME does not require results and body can be released to them

CommunicationRelease 1048576 Local market to assign responsible personnel to logrecord in a book or on a communication

board in the morgue all decedents with pending COVID-19 test results The assigned personnel

must provide the result and update the status in the morgue when the final results are received

1048576 Tag on body bag should be removed (if testing negative) or changed to COVID-19 positive

1048576 The assigned personnel must notify the coronermedical director or funeral home the decedent is

Covid-19 positive per local hospital notification policy Follow local hospital policy for

notificationrelease to the coronermedical examiner or funeral home that meets local county

state and federal regulatory requirements

1048576 The CoronerMedical ExaminerFuneral home will have their own policies and procedures for the

appropriate handling of a Covid-19 positive decedent once they pick up the body

COVID-19 PPE gloves gown mask (procedural maskN95PAPRCAPR) and eye protectionhttpswwwcdcgovcoronavirus2019-ncovhcpguidance-postmortem-specimenshtml

58

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 59: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Covid-19 Positive

Covid-19 Negative

PUI (Results Pending)

DOA-no Covid -19

testing performed

(Emergency Department)

59

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 60: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

MORGUE LOG - COVID-19 LOG

Enter the DATE body was received with the know COVID-19 STATUS in corresponding box below For a decedent with unknown results enter the date received in the COVID-19 RESULTS PENDING box Once the results are provided the date of the result should be entered in

the COVID-19 POSITIVE or COVID-19 NEGATIVE BOX

PLEASE DO NOT REMOVE FULL SHEETS FROM MORGUE - JUST START A NEW SHEET

Cook County ME does not require results for PUI - you can release to Cook County ME if results are pending - communicate status to ME and if they approve to take you can release

DECEDENT NAME COVID-19 POSITIVE

COVID-19 RESULTS PENDING - DO NOT

RELEASE UNTIL RESULTS RECEIVED

COVID-19 NEGATIVE

Release DateOfficer

JOHN DOE [EXAMPLE] 412020 452020 462020204

60

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 61: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Chapter 9 Contact Numbers

61

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 62: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

IDPH Chicago PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Regular Business Hours After-Hours

Cook 708-633-2000 708-906-0748

DuPage 630-682-7400 630-682-7207

Evanston 847-448-4311 847-448-4311

Grundy 815-941-3404 815-942-0336

Kane 630-208-3801 630-208-3801

Kankakee (Non CRI) 815-802-9400 815-937-8479

Kendall 630-553-9100 630-553-0911

Lake 847-377-8000 847-377-8000

McHenry 815-334-4510 815-344-7421

Oak Park 708-358-5480 708-771-9110

Will County 815-727-8480 815-727-8670

IDPH Edwardsville PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-hours number Method of contact After hours

Bond (618) 664-1442 618-664-5020 Health Dept

Calhoun (618)576-2428 618-576-2417 Sheriff

Clinton (618) 594-2723 618-594-4555 Sheriff

East Side Health District (618) 271-8722 618-409-7855 Cell

Fayette (618) 283-1044 618-463-2404 Sheriff

Greene (217) 942-6961 217-942-6961 Health Dept

Jersey (618) 498-9565 618-463-2921 answering service

Macoupin (217) 854-3223 217-854-3135 Sheriff

Madison (618) 692-8954 618-463-6957 answering service

Monroe (618) 939-3871 618-939-8651 Sheriff

Randolph (618) 826-5007 618-826-5484 Sheriff

St Clair (618) 233-7703 618-301-2907 Cell

62

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 63: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

IDPH Peoria PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

Bureau 815-872-5091 815-875-3344 Sheriff Dispatch

Fulton 309-647-1134 309-547-2277 Sheriff Dispatch

Henderson 309-627-2812 309-867-4291 Sheriff Dispatch

Henry 309-852-0197 309-852-0197 Answering Service

Knox 309-344-2224 309-343-9151 Sheriff Dispatch

LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch

Livingston 815-844-7174 815-822-2178 Cell

Marshall 309-246-8074 309-246-2115 Sheriff Dispatch

McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions

McLean 309-888-5450 888-865-9903 PATH211

Mercer 309-582-3759 309-582-5194 Sheriff Dispatch

Peoria 309-679-6000 309-679-6000 Answering Service

Putnam 815-872-5091 815-925-7015 Sheriff Dispatch

Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch

Stark 309-852-0197 309-852-0197 Answering Service

Tazewell 309-925-5511 309-303-1375 On-Call Cell

Warren 309-734-1314 309-734-8505 Sheriff Dispatch

Woodford 309-467-3064 309-467-2375 Sheriff Dispatch

63

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 64: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

IDPH Springfield PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General Line After-Hours Method

ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch

BROWN 217-773-2714 217-242-9013 Mary Reich

CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong

CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson

HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister

LOGAN 217-735-2317 217-671-2106 Salena Matteson

MASON 309-210-0110 309-222-0213 Administrator-Curt Giben

MENARD 217-535-3102 217-753-6666 other - Diana Wade

MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee

MORGAN 217-245-5111 217-245-5111 Other

PIKE 217-285-4407 800-377-8130217-370-6160 After hours Nurse

SANGAMON 217-535-3102 217-753-6666 other - Diana Wade

SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette

SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman

64

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 65: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

IDPH Champaign PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours General After-Hours Method

Champaign-Urbana

Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour

Options

Clark 217-382-4207 217-826-6393 Clark County Sheriffs Office

Coles 217-348-0530 217-345-0060 Coles Sheriffs Office Non Emergency

Crawford 618-544-8798 618-546-1515 Crawford County Sheriffs Office

Cumberland 217-849-3211 217-232-3211 Administrator

Dewitt-Piatt 217-935-3427 DeWitt or

217-762-7911 Piatt217-519-3380 Administrator

Douglas 217-253-4137 217-253-2913 Douglas County Sheriff

Edgar 217-465-2212 217-251-5440 Administrator

Effingham 217-342-9237 217-342-2101 Effingham County Sheriffs Office

Ford 217-379-9281 217-766-4902 Administrator

Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)

Jasper 618-783-4436 618-783-8477 Jasper County Sheriff

Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch

Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital

Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriffs Department

Shelby 217-774-9555 217-774-3941 Shelby County Sheriff Office

Vermilion 217-431-2662 217-304-3234 Administrator

65

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 66: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

IDPH Marion PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Department Business Hours After-Hours After-Hours Method

Clay 618-662-4406 618-662-4406 Connects to Answering Service

Egyptian 618-273-3326 618-518-0513 Cell Phone Number

Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service

Hamilton 618-643-3522 618-643-3522 Connects to Sheriffrsquos Office After

Jackson 618-684-3143 800-875-0162 Answering Service

Jefferson 618-244-7134 618-383-3025 Cell Phone Number

Marion 618-548-3878 618-322-3878 Cell Phone Number

Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours

Southern Seven 618-634-2297 800-358-7367 Answering Service

Wabash 618-263-3873 618-262-6715 Cell Phone Number

Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information

Wayne 618-842-5166 618-842-5166 Connects to Answering Service

66

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 67: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

IDPH Rockford PHMSRR Local Health Department BusinessAfter-Hours Contact

County Health Business Hours After-Hours

Boone 815-544-2951 Amanda Mehl 815-262-2625

Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriffrsquos Office

DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6

Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher

Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen

Ogle 815-562-6976 815-732-2136 Kyle Auman

Stephenson 815 235 8271 815-235-8252 ndash Craig Beintema

Whiteside (815) 626-2230 815-564-5610 ndash Cheryl Lee

Winnebago (815)720-4000 815-720-4000 ndash Theresa James

67

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 68: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Appendix

68

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 69: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

April 7 2020

COVID-19 Test Orders in Electronic Health Records (EHR)

COVID-19 by PCR (Acute Care) and COVID-19 by PCR (Reference Lab) have been removed as order selections and two new test names for the COVID-19 PCR test performed at Alverno Laboratories has been created

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

COVID-19 RAPID Molecular on-site testing will continue to be performed at the hospitals and available to order in the EHRs This test is performed on-site with a turnaround time of 1 hour

Testing though the Illinois Department of Public Health (IDPH) will continue to be available by contacting the hospital lab

Appendix A

69

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 70: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Epic ChangesWhen COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Will mark the patient as a COVID-19 Suspected on Storyboard except on Outpatients

bull Positive COVID-19 results will display on Storyboard for all patients

bull Does not trigger isolation BPA on Outpatients

bull Suspected and positive inpatients will display on the Infection Prevention worklist

bull Will be available unchecked in all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

70

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 71: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Meditech Changes When COVID is entered in order entry COVID-19 Rapid Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op scrn appear

COVID-19 Rapid Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op scrn is used for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull This order will be for COVID-19 screening of asymptomatic Pre-Operative and Pre-Procedural patients

bull Does not trigger alert for isolation precautions when ordered on outpatients

bull Will be available unchecked on all Pre-Operative and Pre-Procedural order sets

IDPH COVID-19 Order To send a specimen to IDPH the provider should use downtime orders and contact the hospital lab with the IDPH Authorization number and specimen source type (NP)

Appendix A

71

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 72: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Cerner Changes When COVID is entered in order entry COVID-19 RAPID Molecular COVID-19 HiSensitivity PCR and COVID-19 PCR Pre-Op screening appear

COVID-19 RAPID Molecular is for the rapid testing of acutely ill patients requiring admission or emergency procedures This test is performed on-site with a turnaround time of 1 hour

COVID-19 HiSensitivity PCR is for testing of both inpatients and outpatients and is performed at Alverno Laboratories with a turnaround time of 12-24 hours

COVID-19 PCR Pre-Op screening is for screening of asymptomatic Pre-Operative and Pre-Procedural Patients

bull Order displays as COVID-19 by PCR (Acute Care) (COVID-19 PCR Pre-Op screening)

bull This order will be for COVID-19 screening of Pre-Operative and Pre-Procedural patients

bull Will not mark the patient as a COVID PUI on the banner bar

bull Does not order isolation precautions when ordered or resulted

bull Positive COVID-19 results will display on the banner bar

bull Patient does not go to the Infection Prevention worklist

bull Will be pre-checked on all Pre-Operative order sets

IDPH COVID-19 Order If it is necessary to send a specimen to IDPH the IDPH COVID-19 order should be placed under ldquoMiscellaneous Lab Requestrdquo Add COVID-19 in the comment box select specimen type (nasopharyngeal specimen)

Dynamic DocumentationMPages

Appendix A

72

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 73: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Athena Changes

When COVID is entered in order entry covid-19 by PCR is available to order

Appendix A

73

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 74: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Personal Protective Equipment (PPE) Validation of DonningDoffing Guidelines Attestation Appendix B

74

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 75: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Personal Protective (PPE) Validation Checklist for PPE Monitor

Appendix C

75

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 76: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

PUI ISOLATION SIGN INOUT SHEET

Appendix D

T E T L EL

76

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 77: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Appendix E

Infection PreventionLeader Rounding Checklist

Rounding performed by (nametitle) DateTime

Personal Protective Equipment Y N Comments Gowns available

Gloves available

N95s available

Eye protection available

Trash emptynot overflowing

Hand Hygiene Y N Comments Hand sanitizer available

Hand soap available

Paper towels available

Transmission Based Precautions Y N Comments

AirborneContactEye protection signage posted outside of room

Appropriate documentation of isolation precautions in EMR

Airborne isolation room alarm on

Manual negative pressure checks documented Cleaning and Disinfection Y N Comment

Cleaning and disinfection supplies available

Associates can speak to contact time of disinfectant used Personnel Y N Comments

Assigned RN able to demonstrate appropriate donningdoffing practices

Associate contact log posted outside of door and filled out appropriately

Follow Up Items

T E T L EL

77

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 78: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Discharge Instructions for Patients with COVID-19 in Spanish

ENFERMEDAD DEL CORONAVIRUS 2019 (COVID-19) Respuestas a las preguntas maacutes frecuentes

P iquestQueacute es el nuevo Coronavirus (COVID-19)

R Hay muchos tipos de coronavirus que afectan a los humanos incluyendo algunos que frecuentemente causan enfermedades leves del tracto respiratorio superior COVID-19 es una nueva enfermedad causada por un nuevo coronavirus no anteriormente visto en ser humanos El virus COVID-19 detectado por primera vez en Wuhan China donde fue identificado como la causa de un brote de enfermedades respiratorias y el virus se ha propagado al rededor del mundo incluyendo los Estados Unidos y todos los 50 estados Las actualizaciones maacutes recientes del resumen de la situacioacuten estaacuten disponibles en la paacutegina web de Los Centros para el Control y la Prevencioacuten de Enfermedades (CDC por sus siglas en ingleacutes) Enfermedad del coronavirus 2019 (COVID-19)

P iquestCuaacutel es la fuente del virus

R Los coronavirus son una familia grande de virus que son comuacuten en personas y en diferentes especies de animales incluyendo los camellos el ganado (vacas) los gatos y los murcieacutelagos Al principio muchos pacientes en el epicentro del brote de COVID-19 en China teniacutean una conexioacuten a un mercado grande de mariscos y animales vivos sugiriendo transmisioacuten de animal a persona Despueacutes un creciente nuacutemero de pacientes reportaron no tener contacto con mercados de animales indicando transmisioacuten de persona a persona Posteriormente la transmisioacuten de persona a persona fue reportada afuera de China incluyendo a los Estados Unidos

P iquestQueacute significa que COVID-19 es una pandemia global

R Una pandemia es un brote global de una enfermedad Las pandemias ocurren cuando aparece un virus nuevo que infecta a las personas y se puede transmitir de persona a persona Por queacute existe poquito a no inmunidad contra el nuevo virus se propaga mundial El virus que causa COVID-19 estaacute infectando a las personas y se estaacute propagando faacutecilmente de persona-a-persona Se han detectado casos en la mayoriacutea de los paiacuteses del mundo incluyendo los Estados Unidos el cual ha documentado casos en todos los 50 estados

P iquestCuaacuteles son los siacutentomas de COVID-19

R Las personas infectadas con COVID-19 han desarrollado enfermedad de nivel leve a grave con siacutentomas que incluyen fiebre tos dificultad para respirar y potencialmente agotamiento respiratorio 2-14 diacuteas despueacutes de la exposicioacuten Si usted piensa que fue expuesto al virus COVID-19 y desarrolla fiebre y siacutentomas como tos o dificultad para respirar llame a su doctor para recibir consejo meacutedico

P iquestCoacutemo se propaga el COVID-19

R El COVID-19 ha demostrado propagarse entre personas La persona que tiene la enfermedad activa (muestra siacutentomas) puede transmitir la enfermedad a otras personas Por eso los CDC recomiendan que estos pacientes sean aislados en el hospital o en casa (dependiendo de la gravedad de su enfermedad) hasta que esteacuten mejor y ya no representen un riesgo de infeccioacuten para los demaacutes

Appendix F

78

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 79: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

El coronavirus en ser humanos tiacutepicamente se propaga a traveacutes de las gotitas respiratorias que se producen cuando una persona infectada tose o estornuda El tiempo que uno tiene la enfermedad activa (muestra siacutentomas) puede variar asiacute que la decisioacuten de cuaacutendo se le puede permitir salir del aislamiento deberaacute tomarse seguacuten cada caso en particular y en consulta con meacutedicos expertos en la prevencioacuten y el control de infecciones y funcionarios de salud puacuteblica Esta decisioacuten implicaraacute tener en cuenta las caracteriacutesticas especiacuteficas de cada situacioacuten lo cual incluye la gravedad de la enfermedad sus sentildeales de enfermedad y siacutentomas y los resultados de las pruebas de laboratorio del paciente

La guiacutea actual de los CDC acerca de cuaacutendo estaacute bien permitirle a alguien salir del aislamiento es de evaluar caso por caso y cumplir todos los requisitos mencionados a continuacioacuten

bull El paciente no tiene fiebre sin el uso de medicamentos para bajar la fiebrebull El paciente ya no muestra siacutentomas incluida la tosbull El paciente obtuvo dos resultados negativos en dos pruebas respiratorias consecutivas recolectadas

con un miacutenimo de 24 horas entre ellas

Cuando la persona sale del aislamiento ya no representa un riesgo de infeccioacuten para los demaacutes

P iquestComo se diagnostica el COVID-19

R El diagnoacutestico ocurre haciendo pruebas de especiacutemenes respiratorios en un laboratorio Algunas cepas de coronavirus causan el resfriado comuacuten y los pacientes evaluados por su doctor pueden tener resultados positivos para estos tipos de cepas

P iquestPuede alguien transmitir el virus sin estar enfermo

R Se cree que personas son maacutes contagiosas cuando estaacuten sintomaacuteticas (lo maacutes enfermizo) La transmisioacuten tambieacuten es posible antes de demostrar siacutentomas Hay reportes de que esto ha ocurrido con COVID-19 pero no se cree que eacutesta sea la manera principal de transmisioacuten

P iquestEl tiempo caacutelido detendraacute el brote de COVID-19

R Auacuten se desconoce si el tiempo y la temperatura afectaraacuten la propagacioacuten del COVID-19 Algunos otros virus como los del resfriado comuacuten o de la influenza (gripe) se propagan maacutes durante los meses friacuteos pero eso no significa que es imposible enfermarse a causa de uno de esos virus durante otros meses En estos momentos no se sabe si la propagacioacuten del COVID-19 se reduciraacute cuando el tiempo se ponga maacutes caacutelido Hay mucho maacutes que aprender acerca de la transmisibilidad gravedad y otras caracteriacutesticas asociadas al COVID-19 y las investigaciones estaacuten en curso

P iquestQue es distanciamiento social

A Distanciamiento social es deliberadamente aumentar el espacio fiacutesico entre personas para evitar la transmisioacuten de enfermedad Mantener una distancia de por lo menos 6 pies reduce el riesgo de contraer el virus COVID-19 Otros ejemplos de distancia social con la meta de evitar grupos grandes de personas espacios concurridos y reuniones grandes Se recomienda trabajar desde su hogar en lugar de la oficina cerrar escuelas y cambiar a clases por internet visitar a seres queridos por medio de aparatos electroacutenicos en vez de en persona suspender servicios religiosos y cancelar o posponer reuniones grandes

P iquestQue estaacute recomendando el estado sobre la distancia social 79

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 80: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

R El Gobernador JB Pritzker ha prohibido reuniones puacuteblicas y privadas de 50 personas o maacutes hasta el 1 de mayo Esto incluye eventos comunitarios ciacutevicos ocio puacuteblico eventos religiosos eventos deportivos con espectadores conciertos convenciones y otros eventos similares o actividades que reuacutenen 50 o maacutes personas en un sitio o espacio al mismo tiempo (asesoramientos por los CDC recomiendan que las personas eviten grupos de maacutes de 10 personas)

P iquestPuedo salir al aire libre

R Si salga al aire libre para respirar aire fresco y hacer ejercicio Monte una bicicleta camine con su perro salga a correr La distancia social no significa quedarse en su casa significa evitar contacto cercano con otras personas Recuerde lavarse las manos al volver al hogar y antes de comer

P iquestPuedo ir al supermercado

R Si Compre lo necesario para reducir el nuacutemero de viajes y trate de ir de compras cuando la tienda tiene menos personas Algunos supermercados tienen horas especiales designadas para personas mayores de edad (60 antildeos o maacutes) mujeres embarazadas y personas con defensas deacutebiles para reducir su exposicioacuten a grupos grandes y la posibilidad de exposicioacuten a COVID-19

P iquestCoacutemo puedo protegerme

R Siga los siguientes consejos para prevenir COVID-19

bull Laacutevese las manos frecuentemente con agua y jaboacuten por un miacutenimo de 20 segundos especialmentedespueacutes de soplarse la nariz toser o estornudar despueacutes de usar el bantildeo y antes de comer ypreparar comida Si no tiene jaboacuten y agua disponible use un desinfectante que contenga por lomenos 60 de alcohol

bull No se toque los ojos nariz y boca sin lavarse las manosbull Evite el contacto cercano con personas enfermas con siacutentomas respiratoriosbull Queacutedese en casa cuando esteacute enfermobull Cuacutebrase con un pantildeuelo de papel al toser o estornudar y despueacutes tire el pantildeuelo a la basurabull Limpie y desinfecte los objetos y las superficies que se tocan con frecuenciabull Si no ha hablado con su meacutedico sobre la vacuna contra la influenza haacutegalo ahora para protegerse

contra la gripe estacional

P iquestDebo usar mascarilla

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida

o a recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no sepueda quitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de saludbull Siga manteniendo una distancia de 6 pies entre usted y otras personas La mascarilla de tela no

sustituye la distancia social

P iquestQueacute pasos deben tomar padres para proteger a sus hijos

80

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 81: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

R COVID-19 es un virus nuevo y auacuten estamos aprendiendo sobre eacutel Hasta el momento no hay muchos nintildeos afectados La mayoriacutea de los afectados incluyendo enfermedades graves han ocurrido en adultos en edad de trabajar y en ancianos Recomendamos que los nintildeos y joacutevenes no se reuacutenan cuando salgan de la escuela para modo de prevenir la transmisioacuten del virus en la comunidad Recueacuterdeles que se laven sus manos frecuentemente y tambieacuten sigan los otros consejos de prevencioacuten

P iquestQuieacuten son las personas en alto riesgo

R El virus COVID-19 es una nueva enfermedad y estamos aprendiendo maacutes sobre ella todos los diacuteas En los adultos mayores y personas con ciertas condiciones meacutedicas el riesgo es maacutes alto y estas condiciones meacutedicas pueden empeorar con el COVID-19 En acuerdo con la informacioacuten disponible hasta las fecha CDC dice que las siguientes condiciones son de maacutes alto riesgo

P iquestDebo de limpiar las superficies que se tocan con frecuencia

R Si Limpiar y desinfectar a menudo objetos que tocan con frecuencia como mesas manillas de puerta interruptor de luz encimeras manijas escritorios teleacutefonos teclados la taza del inodoro las llaves de agua y lavabos Si las superficies estaacuten sucias liacutempie con detergente o jaboacuten y agua antes de desinfectar Para desinfectar los productos desinfectantes maacutes comunes que estaacuten registrados en el EPA son eficaces

P iquestExiste una vacuna

R No En este momento no hay vacuna para COVID-19

P iquestQue tratamiento existe para el COVID-19

R En este momento no existe un tratamiento especiacutefico recomendado para enfermedades causadas por el COVID-19 La atencioacuten meacutedica ayuda a aliviar los siacutentomas

P iquestQue deben hacer los meacutedicos o proveedores de salud los

laboratorios y los departamentos de salud

bull Se puede propagar el COVID-19 a otras personas aun cuando no se siente enfermobull Todos deben usar una mascarilla de tela cuando salen al puacuteblico por ejemplo a la tienda de comida o a

recoger otras necesidadeso No se le debe poner cubrebocas a los nintildeos menores de 2 antildeos a quienes tengan dificultades

para respirar a los discapacitados a los inconscientes o cualquier persona quien no se puedaquitar la mascarilla sin ayuda

bull El propoacutesito de la mascarilla de tela es de proteger a otras personas en caso de que usted esteacuteinfectado

bull No use mascarillas disentildeadas para trabajadores de salud Siga manteniendo una distancia de 6 piesentre usted y otras personas

bull La mascarilla de tela no sustituye la distancia socialo Personas mayores de 65 antildeoso Personas que viven en asilos y hogares de ancianos y vida asistidao Mujeres embarazadaso Cualquier persona sin importar la edad con las siguientes condiciones meacutedicas en particular si

no estaacuten siendo controladas con tratamientos Enfermedad croacutenica pulmonar o asma Insuficiencia cardiaca congestiva o enfermedad de la arteria coronaria 81

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 82: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Diabetes Condiciones neuroloacutegicas que debilitan la habilidad de toser Sistema inmunoloacutegico deacutebil Anemia falciforme Enfermedad renal croacutenica que requiere diaacutelisis Cirrosis del hiacutegado Falta de bazo o un bazo que no funciona correctamente Sobrepeso extremo (el iacutendice de masa corporal equivalente a 40 o maacutes)

bull R Los meacutedicos o proveedores de salud y los laboratorios deben de reportar casos sospechosos deCOVID-19 inmediatamente (dentro de 3 horas) al departamento de salud local quienes notifican a IDPHinmediatamente (dentro de 3 horas) tambieacuten Para recomendaciones y guiacuteas vea la paacutegina de IDPHCoronavirus o la paacutegina web del CDC 2019 Novel Coronavirus

P iquestQue estaacuten haciendo los departamentos de salud puacuteblica en Illinois al

respeto de esta situacioacuten

R IDPH y los departamentos locales de salud puacuteblica han implementado vigilancia intensificada para identificar y examinar pacientes maacutes probables a tener COVID-19 Los expertos de salud puacuteblica estaacuten comunicaacutendose y educando a los proveedores meacutedicos y otros socios de salud puacuteblica acerca de la situacioacuten corriente Se estaacuten desarrollando medidas para prevenir la propagacioacuten de la enfermedad en Illinois Comunicaciones dirigidas al puacuteblico se haraacuten disponibles por la paacutegina de IDPH Coronavirus

Informacioacuten para viajeros se encuentra en la paacutegina del CDC aquiacute httpswwwcdcgovcoronavirus2019-ncovtravelersindexhtml

Page Last Reviewed April 1 2020

82

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 83: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Medidas para ayudar a prevenir la propagacioacuten del COVID-19 si

estaacute enfermo

Siga los pasos a continuacioacuten si estaacute enfermo con COVID-19 o cree que podriacutea tener esta enfermedad siga los pasos a continuacioacuten para cuidarse a siacute mismo y ayudar a proteger a otras personas de su hogar y comunidad

Queacutedese en casa excepto para conseguir atencioacuten meacutedica

bull Permanezca en el hogar La mayoriacutea de las personas con COVID-19 tienen una enfermedad leve y puedan recuperarse en casa sin atencioacuten meacutedica No salga de su casa excepto para buscar atencioacuten meacutedica No visite aacutereas puacuteblicas

bull Cuiacutedese Descanse y manteacutengase hidratado bull Manteacutengase en contacto con su meacutedico Llame antes de recibir atencioacuten meacutedica Aseguacuterese de

obtener atencioacuten meacutedica si tiene problemas para respirar o tiene alguacuten signo de advertencia de emergencia o si considera que se trata de una emergencia

bull Evite el transporte puacuteblico los vehiacuteculos compartidos y los taxis

Manteacutengase separado de las demaacutes personas y las mascotas de su casa

En la medida de lo posible permanezca en una misma habitacioacuten y alejado de otras personas y mascotas en su casa Tambieacuten deberiacutea usar otro bantildeo si tiene uno disponible Si necesita estar con otras personas o animales dentro o fuera de su casa use una cubierta de tela para cara

bull Vea COVID-19 y los animales si tiene preguntas sobre las mascotas

Maacutes detalles Si alguien en su casa estaacute enfermo

Appendix G

83

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 84: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Vigile sus siacutentomas

bull Los siacutentomas comunes del COVID-19 incluyen fiebre y tos La dificultad para respirar es un siacutentoma maacutes grave que significa que debe recibir atencioacuten meacutedica

bull Siga las instrucciones de cuidado de su proveedor de atencioacuten meacutedica y departamento de salud local Las autoridades de salud locales le brindaraacuten indicaciones sobre coacutemo verificar sus siacutentomas y notificar la informacioacuten

iquestCuaacutendo buscar atencioacuten meacutedica

Si manifiesta alguno de estos signos de advertencia de emergencia de COVID-19 busque atencioacuten meacutedica de inmediato

bull Dificultad para respirar bull Dolor o presioacuten persistente en el pecho bull Confusioacuten o dificultad para estar alerta que no haya tenido antes bull Coloracioacuten azulada en los labios o el rostro

Esta lista no incluye todo Consulte a su proveedor de servicios meacutedicos por cualquier otro siacutentoma grave o que lo preocupe

Llame al 911 si tiene una emergencia meacutedica informe al operador que tiene o cree que podriacutea tener COVID-19 De ser posible coloacutequese una cubierta de tela para cara antes de que llegue el personal de servicios meacutedicos

Llame antes de ir al meacutedico

bull Llame antes Muchas visitas meacutedicas de rutina se estaacuten posponiendo o realizando por teleacutefono o telemedicina

bull Si tiene una cita meacutedica que no puede posponer llame al consultorio de su meacutedico e infoacutermeles que tiene o podriacutea tener COVID-19 Esto ayudaraacute al personal del consultorio a protegerse y proteger a otros pacientes

84

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 85: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Si estaacute enfermo use una cubierta de tela para la cara sobre su nariz y boca

bull Deberiacutea usar una cubierta de tela para la cara que cubra la nariz y la boca si debe estarrodeado de otras personas o animales incluidas las mascotas (incluso en su casa)

bull No necesita usar la cubierta de tela para cara si estaacute solo Si no puede ponerse una cubierta de telapara la cara (por ejemplo porque tiene dificultad para respirar) cuacutebrase de alguna otra manera altoser y estornudar Procure mantenerse a al menos 6 pies de distancia de otras personas Estoayudaraacute a proteger a las personas que lo rodean

Nota Durante la pandemia del COVID-19 las mascarillas de uso meacutedico estaacuten reservadas para los trabajadores de la salud y cierto personal de respuesta a emergencias Es posible que deba improvisar una cubierta de tela para la cara con una bufanda o un pantildeuelo

Maacutes detalles Cubiertas de tela para la cara

Cuacutebrase la nariz y la boca al toser y estornudar

bull Cuacutebrase la boca y la nariz con un pantildeuelo desechable al toser o estornudarbull Bote los pantildeuelos desechables usados en un cesto de basura con bolsabull Laacutevese las manos inmediatamente con agua y jaboacuten por al menos 20 segundos Si no dispone de

agua y jaboacuten liacutempielas con un desinfectante de manos a base de alcohol que contenga al menosun 60 de alcohol

Liacutempiese las manos con frecuencia

bull Laacutevese las manos con frecuencia con agua y jaboacuten por al menos 20 segundos Esto es de sumaimportancia luego de sonarse la nariz toser o estornudar despueacutes de ir al bantildeo y antes de comero preparar comidas

85

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 86: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

bull Use un desinfectante de manos si no tiene agua y jaboacuten Use un desinfectante de manos a basede alcohol con al menos un 60 de alcohol y cubra toda la superficie de sus manos frotaacutendolasentre siacute hasta sentirlas secas

bull El agua y el jaboacuten son la mejor opcioacuten en especial si las manos estaacuten visiblemente suciasbull Evite tocarse los ojos la nariz y la boca con las manos sin lavar

Maacutes detalles Consejos sobre el lavado de manos

Evite compartir artiacuteculos del hogar de uso personal

bull No comparta platos vasos tazas cubiertos toallas o ropa de cama con otras personas de sucasa

bull Luego de usar estos artiacuteculos laacutevelos bien con agua y jaboacuten o coloacutequelos en el lavaplatos

Limpie todas las superficies de contacto frecuente todos los diacuteas

bull Limpie y desinfecte las superficies de contacto frecuente en la habitacioacuten del enfermo y el bantildeoPermita que otra persona limpie y desinfecte las superficies en las aacutereas comunes pero no suhabitacioacuten y bantildeo

bull Si un cuidador u otra persona necesita limpiar y desinfectar la habitacioacuten o el bantildeo de unapersona enferma debe hacerlo seguacuten sea necesario El cuidador u otra persona debe usarmascarilla y esperar tanto como sea posible luego de que la persona enferma haya usado el bantildeo

Las superficies de contacto frecuente incluyen teleacutefonos controles remotos mostradores mesones manijas de puertas griferiacutea del bantildeo inodoros teclados tabletas y mesas de noche

bull Limpie y desinfecte las aacutereas que puedan tener sangre heces o liacutequidos corporales en susuperficie

bull Use limpiadores y desinfectantes de uso domeacutestico Limpie el aacuterea u objeto con agua y jaboacuten uotro detergente si estaacute sucio Luego use un desinfectante de uso domeacutestico

bull

o Aseguacuterese de seguir las instrucciones que figuran en la etiqueta para garantizar un usoseguro y eficaz del producto Muchos productos recomiendan mantener la superficie huacutemedadurante algunos minutos para asegurar la eliminacioacuten de los microbios Muchos tambieacuten

86

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 87: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

recomiendan tomar ciertas precauciones como usar guantes y asegurarse de tener buena ventilacioacuten mientras esteacute usando el producto

o La mayoriacutea de los desinfectantes de uso domeacutestico registrados en la EPA deberiacutean ser efectivos Podraacute encontrar una lista completa de desinfectantes aquiacuteiacutecono de sitio externo

Maacutes detalles Guiacutea completa para la desinfeccioacuten

Coacutemo discontinuar el aislamiento en el hogar

Las personas con COVID-19 que se han quedado en su casa (aislamiento en el hogar) pueden finalizar este aislamiento bajo las siguientes condiciones

bull Si no se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se cumplan estas tres condiciones

o No haber tenido fiebre durante al menos 72 horas (es decir tres diacuteas completos sin fiebre sin el uso de medicamentos para reducirla) Y

o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar hayan mejorado) Y

o que hayan pasado al menos 7 diacuteas desde la aparicioacuten de los siacutentomas bull Si se haraacute la prueba para determinar si auacuten es contagioso puede salir de su casa cuando se

cumplan estas tres condiciones o Que ya no tenga fiebre (sin el uso de medicamentos para reducirla)

Y o que los otros siacutentomas hayan mejorado (por ejemplo cuando su tos o dificultad para respirar

hayan mejorado) Y

o tener resultados negativos en dos pruebas seguidas con 24 horas de diferencia Su meacutedico seguiraacute las directrices de los CDC

En todos los casos siga las guiacuteas de su proveedor de atencioacuten meacutedica y departamento de salud local La decisioacuten de finalizar el aislamiento en el hogar deberiacutea tomarse con el asesoramiento de su proveedor de atencioacuten meacutedica y departamentos de salud estatal y local Las decisiones locales dependen de las circunstancias locales

Maacutes detalles Guiacutea para discontinuar el aislamiento

87

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves
Page 88: COVID-19 Infection Prevention Acute Care Playbook...2020/08/07  · patient care Limit face-to-face HCP encounters with patients Exclude visitors to patients with known or suspected

Appendix H

88

  • COVID-19-infection-prevention-acute-care-playbook-7222020
  • 72020CDC Guidance on Optmizing PPE Supplies
  • Guidelines for PPEpdf
    • N95s with valves 08062020pdf
      • N95 Masks with Exhalation valves
      • N95 Masks with Exhalation valves