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As the country begins to see greater stabilization in surge levels within hospitals and a lower incidence of COVID-19 cases, healthcare facilities can begin implementing plans to reopen care sites for patients needing non-emergent, non-COVID-19 healthcare. Postponed elective procedures, chronic disease care and preventive care will restart in a phased approach.

 

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Healthcare facilities should understand guidelines to ensure their workforce and patients remain safe. Once organizations meet Federal Gating Criteria, state and regional preparedness responsibilities, postponed or delayed care can resume, as clinically appropriate.

Note: Each state is instituting their own phasing guidelines. Please refer to the state specific guidelines and the specific services that are resuming within each phase.

If healthcare systems or clinicians have flexibility to re-start clinically, necessary care for patients with non-COVID-19 needs or complex chronic disease management requirements they should consider the following guidance from the Center for Medicare and Medicaid Services (CMS) to ensure the safety of their employees and patients.

 

General Considerations

  • In coordination with State and local public health officials, facilities/clinics should evaluate and confirm the downward incidence and trends for COVID-19 in the area.
  • Evaluate the necessity of the care based on clinical needs. Facilities should work with providers to prioritize surgical/procedural care and high-complexity chronic disease management; however, select preventive services may also be highly necessary.
  • Facilities should consider establishing Non-COVID Care (NCC) zones that would screen all patients for symptoms of COVID-19, including temperature checks. Conduct routine screening for all workforce who will work in the facility (physicians, nurses, housekeeping, delivery and all people who would enter the area).
  • Sufficient resources should be available to the facility across phases of care, including PPE, healthy workforce, facilities, supplies, testing capacity and post-acute care, without jeopardizing surge capacity within their respective

 

Personal Protective Equipment

  • Consistent with CDC’s recommendations, healthcare providers and staff should wear surgical facemasks at all times. During procedures involving a higher risk of aerosol transmission (mucous membranes including the respiratory tract), staff should utilize appropriate respiratory protection such as N95 masks and face shields.
  • Patients should wear a surgical mask if Purchased or handmade cloth face coverings are also acceptable if surgical masks are limited.
  • When possible, facilities should conserve personal protective equipment, even as elective cases resume. cdc.gov/coronavirus/2019-ncov/hcp/ ppe-strategy/index.html

 

Workforce Availability

  • Routinely screen healthcare staff for symptoms of COVID-19. If staff are symptomatic, they should be tested and quarantined.
  • Staff who will be working in NCC zones should be limited to working in these areas and not rotate into “COVID-19 Care zones”.
  • Staffing levels in the community must remain adequate to cover a potential surge in COVID-19 cases.

 

Facility Considerations

  • Facilities should create areas of NCC to reduce the risk of COVID-19 exposure and transmission; these areas should  be separate from other facilities to the degree possible (i.e., separate building, or designated rooms or floor with a separate entrance and minimal crossover with COVID-19 areas).
  • Within the facility, establish administrative and engineering controls to facilitate social distancing, such as phone/online pre-registration, utilizing telehealth, minimizing time in waiting areas, spacing chairs at least six feet apart and maintaining low patient volumes.
  • Separate patients with respiratory symptoms so they are not waiting with other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients and visitors to be separate.
  • Prohibit visitors unless they are necessary for an aspect of patient care. If  visitors are necessary, implement pre-screening protocols in the same way as patients.

 

Sanitation Protocols

  • Ensure that there is an established plan for thorough cleaning and disinfection prior to using spaces or facilities for patients with non-COVID-19 care needs.
  • Following CDC guidelines, thoroughly decontaminate any equipment used for COVID-19 (+) patients, such as anesthesia machines.
  • Promote frequent and thorough hand washing, including by providing workers, patients and visitors with a place to wash their hands. If soap and running  water are not immediately available, provide alcohol-based hand rubs containing at least 60% alcohol.
  • Post visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene and cough etiquette.

 

Supplies

  • Adequate equipment, medication and supplies must be ensured, and not detract from the community’s ability to respond to a potential surge.

 

Testing Capacity

  • Screen all patients for potential symptoms of COVID-19 prior to entering the NCC facility/clinic.
  • When adequate testing capability is established, screen staff and patients before care using laboratory testing.

 

All facilities should continually evaluate whether their region remains a low risk of incidence and should be prepared to cease non-essential procedures if there is a surge in COVID-19 cases.

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