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COVID-19 Update | April 14, 2020
Guidelines on the Treatment and Management of Patients with COVID-19 (IDSA, Apr. 11)
IDSA has just released evidence-based rapid guidelines to address the most pressing clinical questions related to caring for patients with COVID-19. These are the first in a series of guidelines to be released by an IDSA-convened multidisciplinary panel of experts including SHEA representatives.   These guidelines will be updated frequently as more evidence emerges.  Additional guidelines on diagnostic testing and infection prevention are now in development.
 
CDC recently updated its infection prevention and control interim guidance for PUIs in healthcare settings. SHEA members should note the following key points in the updated guidance:   
  • Cloth face coverings should not be considered PPE and should NOT be worn instead of a respirator or facemask if more than source control is required.
  • Healthcare personnel should consider continuing to wear their respirator or facemask (extended use) while in the healthcare facility instead of intermittently switching back to their cloth face covering, which could cause self-contamination. Healthcare personnel should remove their respirator or facemask and put on their cloth face covering when leaving the facility at the end of their shift.
  • Visitors and patients should be wearing their own cloth face covering upon arrival to the facility per CDC recommendations to the general public. If they are not, they should be offered a facemask or cloth face covering, as supplies allow, and instructed to wear it while in the facility.
  • This recommendation does not change CDC's guidance for healthcare personnel to use N-95 or equivalent respirators when providing care for patients with suspected or known COVID-19.
  • Facilities that do not have sufficient supplies of N-95s and equivalent respirators for all patient care should prioritize their use for activities and procedures that pose high risks of generating infectious aerosols, using facemasks for care that does not involve those activities or procedures. Once availability of supplies is reestablished, N-95s and equivalent respirators use should resume for all workers caring for these patients.
  • Facilities should consider utilizing CDC's PPE optimization guidance and PPE Burn Rate Calculator in order to preserve PPE supplies and keep workers safe. 
SHEA continues to connect with the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to inform our members about what is happening on the ground in our healthcare facilities.  If you have comments to share, please email Kristy Weinshel.
 
CAUTION: PPE Distributor Scams
Colleagues in the healthcare supply chain and distribution industry have shared that several hospitals have fallen victim to scammers who claim to have access to PPE supplies in shortage. These unscrupulous actors request some or all of the payment for orders up front. These orders never arrive at facilities and hospital administrators find disconnected phone numbers and email addresses by the time they realize they have been duped.
 
We are aware persistent PPE shortages throughout all healthcare systems are untenable and SHEA is doing everything we can to support frontline healthcare workers in conveying the dire need for PPE to federal officials. We understand hospitals will do what is necessary to secure PPE whenever an opportunity arrives. Our colleagues in the healthcare supply chain industry strongly recommend that all vendors be carefully vetted before orders are submitted and paid for. Federal officials are aware of these scams and steps are being taken to identify and stop this criminal activity.
3 Minute Recap
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SHEA Coronavirus News
COVID-19 by the Week Survey
We are tracking SHEA members' experiences week-by-week. Responses are anonymous for a 4-question survey. The first 2 questions are demographic, and the second two are about current status and primary concerns. A summary from last week's survey is below.
 
Please complete the questions for this week. April 12-18:
Federal Agency News, Guidance, and Guidelines
Infection Prevention and Control
 
 
Clinical Care and Treatment
 
 
Special Settings and Populations
 

Testing and Cases
 
 
Incident Management
 
Communication Resources
 
Payment and Reimbursement Policy
 
Workforce and Scope of Practice
 
Tools and Resources
Prevention CHKC 
The Prevention Course in HAI Knowledge and Control (Prevention CHKC) is an online, interactive course designed to give frontline healthcare personnel what they need to help prevent healthcare-associated infections (HAIs). This course engages and commits personnel to critical elements of infection prevention and control in concise, half-hour long modules. The authors – foremost experts in epidemiology, infection prevention, and antibiotic stewardship – prioritized HAI prevention practices that are most necessary and relevant to frontline personnel.
 
Modules:
  • Clean Hands
  • Clean Environment
  • Occupational Health
  • Diagnostic & Antibiotic Stewardship
  • Precautions & PPE
  • CAUTI & CLABSI
  • Pneumonia
  • MRSA & MDROs
  • C. difficile
  • Surgical Site Infection
Given the urgent need to provide training in PPE donning and doffing, environmental cleaning, pneumonia prevention, and other topics during the COVID-19 pandemic we are offering the course free through May 31st with the use of the discount code – COVID19.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
ACCESS ON LEARNINGCE
Podcast episodes will launch every Thursday. Each week's episode will include a summary of important news items, medical literature and guidelines on infection prevention that have been published related to COVID-19, and a discussion around the latest and most important questions surrounding the outbreak.
  • Episode 1: Frequently Asked Questions – available now
  • Episode 2: Environment of Care and PPE – available now
  • Episode 3: Surge Planning & Testing – available now
  • Episode 4: Diganostic Testing – available now
  • Episode 5: PPE Conservation & Shortages – available now
  • Episode 6: Diagnostic Testing, Part 2 – available now
  • Episode 7: Involving Antimicrobial Stewardship Programs – available now
SHEA Rapid Response Webinars
ACCESS ON LEARNINGCE
  • SHEA COVID-19 Town Hall
  • SHEA COVID-19 Town Hall, Round 2
  • SHEA COVID-19 Town Hall, Round 3
    Live Q&A with SHEA Leaders on questions Healthcare Epi is facing during this pandemic.
  • Healthcare Facility Outbreak Preparedness
    The webinar addresses what healthcare facilities/providers can do in both the inpatient and outpatient setting to decrease the risk of outbreaks, especially regarding novel respiratory viruses. The role of planning and simulation is discussed, as well as the need to train healthcare workers to utilize PPE correctly.
Event Announcements
Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19) 
Thurs., Apr. 16, 2:00 p.m. to 3:00 p.m. ET
Presenters: Robert N. Anderson, PhD, Margaret Warner, PhD, Lee Anne Flagg, PhD, Farida Ahmad, MPH
 
NHSN COVID-19 Module Update - Training for Users
Tues., Apr. 14, 2:00 pm ET
CDC's National Healthcare Safety Network (NHSN) plans to release two new additional data collection pathways in the COVID-19 Module this week.
Trade Press & Journal Articles
ICHE Coronavirus and COVID-19 Article Collection 
The editors of ICHE have created a page for on the ICHE web site for COVID-19 related articles, commentaries, and letters to the editor.  All COVID-19 manuscripts in their accepted form are freely available. Check back frequently for updates.
 
We encourage all our members to submit COVID-19 original research to ICHE.  We want to highlight the important work you are doing during this critical time to showcase the importance of infection prevention. 
Note that ICHE has temporarily suspended print production of journal issues.
 
 
News Highlights
Social Media
@SHEA_Epi: If you're going to wear a home-made mask, it should not replace physical distancing, good hand hygiene and the instructions about not touching your face, eyes, nose and mouth, and, of course, sheltering at home." SHEA Past President @dan_diekema #COVID19 https://twitter.com/SHEA_Epi/status/1248355779993796608
 
@SHEA_Epi: SHEA's Past-President Dr. Mark Rupp shares some tips to keep in mind when physicians, nurses and other health professionals return home to continue to protect their families from #COVID19. @AmerMedicalAssn https://twitter.com/SHEA_Epi/status/1248314536018526210
 
@Dr_Mike_Stevens: Had the great opportunity to record this @SHEA_Epi podcast w/@jpogue1 & @DavidBBanach on involving #AntimicrobialStewardship programs in #COVID-19 response efforts; based on @ICHEJournal letter written w/ the great abx stewards @Payal_Patel & @BronxASP!
https://twitter.com/Dr_Mike_Stevens/status/1248339259033112576
Federal Policy Updates
COVID-19 Multisector Stakeholder Call (Apr. 9)
Organizational representatives from several sectors involved in the COVID-19 response discussed what they are hearing on Capitol Hill and other policy influencers, as well as some of their challenges and concerns. Among the common themes are:
  • Confusion persists over which executive agency and appointee is in charge of oversight and management of the PPE shortages. There are many stories in the public domain concerning whether hospitals and states are responsible for managing their PPE shortages locally and what if any federal assistance is available or can be expected. Some have reported seizures of PPE at the border by federal authorities even though these imports were ordered by entities procuring these supplies for healthcare facilities seeking to fulfill orders. Reports of healthcare systems, state governors, and federal authorities engaging in competitive bidding over the same pool of supplies continues to persist.
  • Capitol Hill leaders continue to express concerns over PPE, testing materials and ventilator shortages.
  • In addition to the known shortages around testing materials, access to materials needed for test sample extraction is now in shortage.
  • Development and broad distribution for serology tests will be challenging as these differ from diagnostic testing development and distribution. Serology testing is expected to be an important issue for COVID-19 and in future policy discussions around emergency preparedness. These tests will be a key factor in deciding when to initiate working toward "business as usual" for the American economy.
  • Public health groups have been working hard on contact tracing infrastructure needs and related federal funding support.
  • Many Capitol Hill offices are reaching out to stakeholder organizations asking questions that appear to stem from a paper published by Gottlieb, McClellan and colleagues, A National COVID-19 Surveillance System Achieving Containment.  This white paper may be a significant resource for informing programmatic and funding priorities for "CARES 2," the next emergency supplemental funding bill being crafted by Congress.
  • The fourth emergency funding supplemental, "CARES 2" may not be finalized before May. Hill staffers continue to work on scope and language.
  • Many organizations are pursuing advocacy on disparity and equity issues.
CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week (Apr. 7) 
In order to increase cash flow to providers of services and suppliers impacted by the 2019 Novel Coronavirus (COVID-19) pandemic, CMS has expanded its Accelerated and Advance Payment Program to include a broader group of Medicare Part A providers and Part B suppliers. The expansion of this program is authorized under the CARES Act (P.L. 116-136) and is enacted only for the duration of the public health emergency. Details on the eligibility, and the request process are outlined in a fact sheet that can be found through this link and in the above "Payment and Reimbursement Policy" section of this update.
 
FEMA Supply Chain Task Force Leads Four-Pronged Approach to Securing Needed Supplies and Equipment in COVID-19 Fight (FEMA, Apr. 7) 
FEMA released its "Whole-of-America COVID-19 Response" plan outlining its approach to fighting COVID-19. The response is a "locally executed, state managed, and federally supported strategy to meet the demand for critical supplies" and is comprised of four key components: (1) preservation of medical supplies; (2) allocation of supplies to ensure they are at the right place at the right time; (3) acceleration of manufacturing and distribution; and (4) expansion of industry.
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