Editor’s note: Due to the rapidly evolving nature of the worldwide COVID-19 (Coronavirus Disease 2019) outbreak, faculty and staff are strongly encouraged to stay tuned to their work email for updates from Partners HealthCare and Brigham-specific guidance. Visit PikeNotes for additional resources and updates.
On March 3, clinical experts and hospital leaders on the front line of the Brigham’s COVID-19 (Coronavirus Disease 2019) response hosted an open forum to provide an update on preparation efforts and respond to questions from faculty and staff.
In a wide-ranging presentation before a full audience in Bornstein Amphitheater and more than 800 webcast viewers, speakers reviewed what is currently known about the disease, how caregivers should screen and care for potential COVID-19 patients, protocols for using personal protective equipment (PPE), other preventive measures and guidance around travel, furlough and sick time.
“You are all very important to us, to the organization and to the patients and families whom we serve and support. We want you to know, too, that we want to support all of you by making sure that you’re well-educated,” said Jean Jackson, SPHR, SHRM-SCP, RACR, vice president of Human Resources. “It’s really important to us that we keep the lines of communication open and continue to have opportunities to engage.”
Worldwide, most COVID-19 patients have a mild form of the illness, with only 20 percent requiring hospitalization, explained Michael Klompas, MD, MPH, hospital epidemiologist. Of that 20 percent, one-quarter need to be treated in an intensive care unit (ICU). The U.S. Centers for Disease Control and Prevention (CDC) report that the disease has a 2 percent mortality rate as of March 5.
During the open forum, Brigham clinical leaders emphasized the importance of following the Identify, Isolate and Inform protocol (see related box below) for screening patients in inpatient settings, ambulatory areas and the Emergency Department (ED).
In the ED, patients are being screened at registration for fever, cough or respiratory symptoms and recent travel outside the U.S. In the ambulatory setting, teams are screening all patients proactively before their appointment and upon arrival at the clinic.
“What I would ask of everyone is to take a philosophy much like hand-washing,” said Karl Laskowski, MD, MBA, associate chief medical officer for Ambulatory Services. “We need to hold ourselves accountable. If you go into a clinic and see people aren’t asking these questions, politely remind each other we should be asking these patients about fever, cough and travel history.”
Since Jan. 29, a multidisciplinary team has met regularly to develop, update, drill and refine the Brigham’s preparation and response plan in coordination with colleagues across Partners HealthCare and its member institutions. This includes readying the hospital and distributed campus for a variety of potential scenarios, including patient surges, to ensure the Brigham has the supplies, staffing and protocols in place to safely deliver care no matter the circumstances.
For example, ED staff have been conducting ongoing drills in close coordination with the Medical ICU (MICU), where initial patients with a suspected or confirmed case of COVID-19 would receive care, said Janet Gorman, BSN, MHA, associate chief nursing officer for the ED.
An important part of the strategy for managing a potential patient surge will be helping clinicians determine which patients need acute care, which can be monitored at home and which require an intermediate approach, said Eric Goralnick, MD, MS, medical director of Emergency Preparedness.
As drills continue and the first test cases emerge, Goralnick encouraged staff to share their feedback about opportunities for process improvement.
“We need your help to get this right — to ensure that we communicate with all of our teammates, understand where our gaps are and learn from every one of these engagements,” he said.
Jon Boyer, ScD, CIH, director of Environmental Affairs and hospital safety officer, reviewed when and how PPE — including N95 respirators and powered-air purifying respirators (PAPRs) — should be used. To protect critical supplies, N95 masks are being provided at high-risk locations, and PAPRs are available 24/7 from Central Transport.
Boyer also clarified the process for N95 fit-testing. Nearly 6,700 staff have been fit-tested, including those who would most likely assist or care for a COVID-19 patient, such as clinicians, Environmental Services staff and Brigham Police and Security personnel.
Protecting Each Other
To minimize the risk of infection, speakers at the forum advised employees to practice what they normally would do during flu season: frequent hand-washing, staying home if sick and avoiding touching one’s mouth, nose and eyes.
Responding to an audience question about the effectiveness of hand sanitizer versus hand-washing, Meghan Baker, MD, associate hospital epidemiologist, said that alcohol-based hand sanitizer effectively kills coronavirus. She noted that someone who has soiled hands, including direct exposure to blood or other bodily fluids, should wash them with soap and water for at least 20 seconds.
Speakers reiterated that all personnel should stay home if they are sick. Jackson noted that the Human Resources team is working with Partners to review sick-time and remote-work policies.
Staff who stay home because they do not feel well and who cannot perform their job duties remotely will be paid under the guidelines of their paid time-off policy. If an employee does not have enough paid time off available, Partners will advance them up to two weeks of their scheduled hours, as needed. Staff who do not accrue paid time off may use time off available to them per Massachusetts’ Earned Sick Time law. (Learn more.)
Brigham personnel who travel to areas with widespread local transmission of COVID-19 must complete Occupational Health Services’ Returning Traveler Activity Survey, and OHS will communicate when they are allowed to return to work. Employees who have traveled to these areas — regardless of whether or not they have symptoms — will be furloughed from work upon their return date for 14 days. Partners’ TravelSafe website contains the most up-to-date information about what qualifies as an area with widespread local transmission.
For more information, including FAQs and a webcast recording of the March 3 forum, visit BWHPikeNotes.org.
Patient Screening for COVID-19: Identify, Isolate and Inform
Identify: Ask patients if they have a fever, cough or respiratory symptoms and if they have traveled outside the U.S. in the past 30 days.
Isolate: If the patient has a fever or respiratory symptoms and either (1) recent travel to an area with widespread COVID-19 or (2) contact with someone who has a known or suspected case of COVID-19, implement precautions immediately. If the patient is already on site, this includes giving the patient a surgical mask and directing them to a private room, preferably one with negative pressure if available, and closing the door.
Inform: Page the Biothreats Attending (pager #30331). For nonurgent questions, page Infection Control (pager #11482).
For more details about screening protocols, visit BWHPikeNotes.org.