Train the TrainerFor HCW Education

VCH infection Prevention and Control Team Last Updated: March 17, 2020

COVID-19

Resources

BC Nurse Line (811) available 24 hours/day, 7 days/week Canadian and BC response

• PHAC Coronavirus website• BCCDC Coronavirus website• VCH IPAC website (ipac.vch.ca)

International Response• WHO Coronavirus website

International Epidemiology• Johns Hopkins Coronavirus Dashboard• CIDRAP website

Clinical Evidence Reviews• Lancet Coronavirus resource page• NEJM Coronavirus resource page• Public Health Ontario Coronavirus resource page

Coronaviruses (in general)

• Enveloped viruses Cause disease in animals Can cause human disease: typically mild,

like the common cold (CoV 229E, OC43, HKU1 etc…)

Rare variations with outbreak potential: SARS-CoV, MERS-CoV, SARS-COV-2 (COVID-19) cause a range of presentations from asymptomatic, mild, severe

• Are not environmentally hardy Normal hospital cleaning practices are

sufficient Susceptible to soap/water, alcohol hand rub

• Nomenclature COVID-19 (clinical disease) SARS-COV-2 (virus name)

https://coronavirus.jhu.edu/map.html

Canada: Experience Summary

• Canada: 447 cases of COVID-19 presumed/confirmed positive as of March 17

• British Columbia 103 positive cases as of March 144 deaths

Illness Severity

Case-Fatality Rate

2019-nCoV 2-3% among lab confirmed (lower outside Wuhan)

SARS-CoV 9.6% among probable cases

MERS-CoV 34.5% among lab confirmed (WHO)

Uncomplicated: asymptomatic or non-specific symptoms such as fever, cough, sore throat and nasal congestion

Mild pneumonia

Severe pneumonia

ARDS

Sepsis

Septic shock

Treatments

Early supportive care best known interventionHigh risk patients to seek care early. Decompensation may occur days

into illnessNo current vaccination available – multiple international trials ongoingAnti-viral therapies currently experimental and under investigation

Visitors

Infection Prevention Practices for Patients Under Investigation (PUI)

HAND HYGIENE! Place a surgical mask on the patient Encourage respiratory etiquette Place patient in single occupancy room HAND HYGIENE! Use contact and droplet precautionsgloves, gowns, surgical mask and eye protection*if performing Aerosol-Generating-Medical Procedures, use

N95, eye protection and contact precautions

Lab Testing

Red top UTM Copan swab (for NP swabs) Community - Send to BCCDC for COVID-19 testing

For Acute Care Outpatient and clinically stable ER patient: collect a nasopharyngeal (NP) swab or

bronchoalveolar lavage (BAL) Admitted or critically ill patient: collect a NP and lower respiratory specimen

(sputum/tracheal aspirate/BAL) for COVID-19 testing UBCH RHS and LGH - follow your usual process for testing For VCH sites all samples requested for influenza/RSV will be tested for COVID-19 and

vice versa Testing will occur 3 times per day, 7 days/week VCH Microbiology shares specimen with BCCDC

Cleaning & Disinfecting, Laundry & Food

Public Health Agency Canada currently recommends following routine hospital practices: coronaviruses (in general) are not particularly hardyRegular cleaning and disinfection, laundry, and food delivery practicesKey message is to *follow* institutional practicesCleaning and disinfection is 2 steps: wipe clean to remove bioburden and wipe

again to disinfectKey Message - Ensure that your

Infection Control team is in communication with your

Environmental Services team

Resources: ipac.vch.ca

Patient Identification and Assessment tool – Acute Care

ipac.vch.ca COVID-19 Triage & assessment COVID-19 Patient Identification & Assessment

Patient Identification and Assessment tool – Ambulatory Care

ipac.vch.ca COVID-19 Triage & assessment COVID-19 Patient Identification & Assessment

List of Aerosol Generating Medical Procedures (AGMPs)

AGMPs: Medical procedures that generate aerosols or droplet nuclei in high concentration presents a risk for opportunistic airborne transmission of pathogens not otherwise spread by the airborne route.

HIGH RISKEndotracheal intubation/extubation

High frequency oscillatory ventilation

Bronchoscopy

Laryngoscopy

Positive Pressure Ventilation (BiPAP/CPAP)

Sputum induction

OTHERAirway suctioning

High-flow oxygen (optiflow)

Breaking closed ventilation system (ie patient movement)

CPR

Tracheostomy care

Chest physiotherapy

Administration of aerosolizing or nebulizing medication

ipac.vgh.ca COVID-19 Personal protective equipmentAGMP best practices

Infection Control Practices for COVID-19

1. Aerosol generating medical procedure

2. Ventilated patients

MAJORITY OF CASES EXCEPTIONS

Most Important Thing You Must Learn Today: Donning and Doffing of Personal Protective Equipment

Encourage all healthcare providers to review on ipac.vch.ca

Masks should be removed last

Do we have enough masks?

Currently VCH has adequate N95, procedure masks, and face protection for our staff.

There are new allocation processes to preserve the availability of PPE for appropriate use and to prevent theft/misuse.

Like everything else, this situation is evolving so stay tuned for further updates.

Patient Privacy and Confidentiality

Be mindful of patient privacy and confidentiality Staff are accountable for managing patients’ personal information and

confidential information Resources available on SHOP: http://shop.healthcarebc.ca/vch E-Learning module available on https://learninghub.phsa.ca/ :

VCH Privacy and Confidentiality If you are suspicious about the legitimacy of any enquires please seek

direction from your manager or supervisor

Public Health is involved with the monitoring and return to work guidance for Healthcare Workers that

were involved in an exposure to a confirmed case of COVID-19 outside of work.

Provincial Workplace Health Call Centre (WHCC) – Occupational Health Nursing Team is responsible for

the assessment ,monitoring, and return to work guidance for Healthcare Workers (HCW) employed by

VCH who have been identified as having an exposure to a patient confirmed to have COVID-19 while at

work (occupational exposure)

Staff who believe they have been exposed at work and have not heard from the WHCC can assume that patient’s test was negative and there is no COVID-19 exposure.

Staff should continue working and practicing routine precautions and wearing appropriate PPE.

STAFF RESOURCES/SUPPORT

STAFF RESOURCES/SUPPORT

811/BCCDC: Inquiries from Staff who are unclear whether they should be returning to work following

travel should be referred back to the most recent recommendations on travel posted on BCCDC or contact

811.

Managers should also be familiar with these recommendations when considering whether staff should be

at work or not. http://www.bccdc.ca/health-info/diseases-conditions/coronavirus-(novel)#Information--about--the--virus

VCH Infection Control Team is to support patient identification, testing, policies, processes all related to patient care!

Key Messages

• Pandemic initiated as per W.H.O – the world-wide spread of a newly identified virus. Used for newly identified influenza viruses. The word pandemic is not an indication of how severe the virus might be.

• What it means to you: Practice proper hygiene etiquette during the cold and flu season & stay home if you are

sick. If you have a patient/resident/client with symptoms of respiratory illness, give them a

mask and provide them with care using the same level of PPE you would use during any flu season.

If you have health concerns, call HealthLink BC at 811 or your health care provider.

• For more information, visit the province's pandemic preparedness plan. Vancouver Coastal Health's pandemic plans are also posted publicly.

Key Messages

• Risk to BC residents and HCW is currently low• Priorities: public/patient and HCW safety rapid identification/triage, isolation, testing, reporting consistent, sustainable, coordinated provincial-institutional approach Sharing of reliable and accurate information with public and HCWs

• Many levels of checks and balances are in place provincially and with each HA to ensure that the best information is shared!

• Coordinated, provincial response Still in containment phasePreparing for potential wider impact due to international expansion of COVID-19Provincial resources being developed

FAQs

Can patients be co-infected with COVID-19 and X?Why are there differences between PPE practices when responding to

novel infectious threats?Where do I look for return to work after travel to affected areasWhat is effective in cleaning and disinfection?How quickly will COVID-19 results return?How will I be notified of COVID-19 results? Good question!How can I upload the ipac.vch.ca website to my phone home screen?

Acknowledgements & Disclosures

• Dr. Danuta Skowronksi (epi)• Dr. Samuel Chorlton• Dr. Elizabeth King• BCCDC PHL • BC PICNet• Emergency and Critical Care Departments• Public Health MHO’s and CD Nurses• VCH Medical Microbiology Dr Charles, Dr L Li, Dr. J Grant• VCH Infection Prevention and Control• None relevant to this presentation• Information is evolving, and therefore the recommendations are fluid

Novel Coronavirus update (COVID-19)

Titus Wong, MD, MHSc (Epi), FRCPCDivision of Medical Microbiology and Infection Prevention

Regional Medical Director, Infection Prevention and Control, VCH Co-Medical Director, BC Provincial Infection Control Network,

Provincial Health Services AuthorityDepartment of Pathology and Laboratory Medicine, UBC

Marthe Charles, MD, MSc, FRCPCDivision Head, Division of Medical Microbiology and

Infection Prevention, VCHDepartment of Pathology and Laboratory Medicine, UBC

Elizabeth Bryce, MD, DSc, FRCPCInfection Control Officer, Vancouver Acute

Division of Medical Microbiology and Infection PreventionDepartment of Pathology and Laboratory Medicine, UBC

Allison Muniak, MScExecutive Director, Quality, Patient Safety and Infection

Control, Vancouver Coastal Health

We acknowledge that these slides are a part of another presentation :