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COVID-19 Update | April 28, 2020
SHEA-Endorsed Guidelines on Infection Prevention for COVID-19
SHEA-endorsed guidelines "Infection Prevention in Patients with Suspected or Known COVID-19," developed with IDSA and PIDS members, were released on the IDSA website yesterday. Dr. Guzman-Cottrill served as SHEA's official representative, with several other SHEA members on the panel. The SHEA Guidelines Committee and Board provided a thorough review prior to the vote on endorsement.
 
This guideline is part two of a 3-part document also composed of Treatment and Management (SHEA representative Dr. O'Horo; SHEA-endorsed http://www.shea-online.org/index.php/practice-resources) and Diagnostics (SHEA representative Dr. Loeb, coming soon).
 
Each section will be published in CID, but will be updated on the IDSA website when new information emerges. CID will refer back to the website for the most current information. The guideline is also provided on the SHEA Practices Resources page. http://www.shea-online.org/index.php/practice-resources
The guideline is made up of eight recommendations developed under the GRADE methodology to assess certainty of evidence and strength of recommendation:
  1. Masks: healthcare personnel caring for patients with suspected or known COVID-19 use either a surgical mask or N95 (or N99 or PAPR) respirator as part of appropriate PPE (Strong recommendation, moderate certainty of evidence)  
  2. Masks in shortage scenarios: healthcare personnel caring for patients with suspected or known COVID-19 use a surgical mask or re-processed respirator instead of no mask as part of appropriate PPE.
  3. Gloves: no recommendation for use of double gloves vs. single gloves due to lack of evidence
  4. Shoe covers: no recommendation for use shoe covers due to lack of evidence
  5. N95 masks for AGPs: healthcare personnel involved with aerosol-generating procedures (AGPs) on suspected or known COVID-19 patients use an N95 (or N99 or PAPR) respirator instead of a surgical mask, as part of appropriate PPE
  6. Reprocessed N95 masks for AGPs: if respirators are in shortage, healthcare personnel involved with AGPs on suspected or known COVID-19 patients use re-processed N95 respirators should be reused instead of surgical masks 
  7. Extend use of N95s through face shields and surgical masks for AGPs: If re-processed respirators are being used, the panel recommends healthcare personnel involved in AGPs on suspected or confirmed COVID-19 patients use a face shield or surgical mask over the reused respirator to aid extended use, instead of using a surgical mask alone, assuming correct donning and doffing techniques of PPE
  8. Reuse of N95s with face shields and surgical masks for AGPs: To allow for reuse of re-processed respirators during contingency or crisis settings, healthcare personnel involved with AGPs on suspected or known COVID-19 patients add a face shield or surgical mask as a cover for the N95 respirator instead of a using an N95 mask alone
 
Important Message from CDC
 
The Centers for Disease Control and Prevention (CDC) has introduced a new COVID-19 module within NHSN's patient safety component. The initial pathway reports daily counts of hospitalized patients with suspected or confirmed COVID-19 diagnoses and current use and availability of hospital beds and mechanical ventilators, and additional pathways report healthcare worker staffing and supply status and availability. CDC has contracted with Lantana Consulting Group to develop and support an automated submission option for the NHSN COVID-19 module to create greater efficiency for submitters, alleviate burden of reporting on hospitals, and improve data consistency and quality. 
 
An application consisting of an HL7 FHIR questionnaire for the new module has been created and can be integrated into any EHR with a FHIR API providing automatic pre-population of data available within the EHR. The initial application will extract and pre-populate Patient Impact and Hospital Capacity Pathway Sections 1 and 2 of the COVID-19 module—all questions relying on data that adhere to the common interoperability definitions in the US Core Data for Interoperability (USCDI).
 
Hospitals interested in collaborating as "beta testing" sites for the new COVID-19 application are being sought. Participating hospitals should meet the following criteria:
  • Currently reporting to NHSN (HAI, AUR, or other data, i.e., have current access to the NHSN application via SAMS).
  • Utilize an EHR with a FHIR API option (it is not required that the FHIR API be in current use for reporting, just that the vendor has implemented the interface).
  • Provide a technical point of contact and IT resources to complete the beta test – estimated level of effort 10 hours/week over 2 weeks. 
We anticipate that initial integration and testing of the app would take up to 8-10 business days. Lantana Consulting Group will support application integration, functionality, and usability. Lantana will work with hospitals to communicate this innovative approach to reporting which they can extend to state and local public health entities.
 
For inquiries related to technical and informatics support (e.g., app integration and functionality), please contact: NHSNonFHIR@lantanagroup.com
 
For other inquiries related to the application, please contact: WWise@cdc.gov 
 
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. 
  
Please complete the questions for this week. (Apr. 26-May 1): https://www.surveygizmo.com/s3/5567292/COVID-19-by-the-Week-Apr-26-May-1 
Federal Agency News, Guidance, and Guidelines
Infection Prevention and Control
PPE 
Clinical Care and Treatment
 
Special Settings and Populations
Testing and Cases
Incident Management
Payment and Reimbursement Policy
Tools and Resources
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, and a discussion around the latest and most important questions surrounding the pandemic. 
 
Episodes Available Now: 
  • COVID-19 Frequently Asked Questions 
  • Environment of Care & PPE
  • Surge Planning & Testing
  • Diagnostic Testing, Part 1
  • PPE: Conservation & Shortages
  • Diagnostic Testing, Part 2
  • Involving Antimicrobial Stewardship Programs
  • Advocacy around COVID-19
  • PPE: Getting Resourceful with No Resources
  • Taking Care of Yourself
  • Tracing Contacts – available 4/30
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall - March 29
  • SHEA COVID-19 Town Hall, Round 2 - April 5
  • SHEA COVID-19 Town Hall, Round 3 - April 11
  • SHEA COVID-19 Town Hall, Round 4 - April 19
  • SHEA COVID-19 Town Hall, Round 5 - April 26
    Live Q&A with SHEA Leaders on questions Healthcare Epi is facing during this pandemic. 
 
Information for Patients, Visitors, and the General Public
Event Announcements
SHEA COVID-19 Town Hall
Sun., May 3 | 3:00-4:00 p.m. EDT
REGISTER
Join us for round 6 of the SHEA COVID-19 Town Hall to share ideas and ask questions in a discussion moderated by SHEA President, David K. Henderson, MD, FIDSA, FSHEA.
 
NETEC: The Use of Proning - Implications for Your Patients and Your Team
May 1, 12:00 pm, CT
REGISTER
This webinar will discuss the clinical importance and indications of proning, describe the process of proning for COVID-19 cases, and review the strategies employed and lessons learned
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 here. Check back frequently for updates.
 
 
 
News Highlights
Social Media
From the MySHEA Open Forum Discussion (Log In Required)
 
*NEW* MySHEA Dentistry Special Interest Group
A new discussion subgroup has been added to MySHEA (members-only online community) for those interested in sharing information and resources related to COVID-19 infection prevention in the dental setting. To subscribe, email Lbrady@shea-online.org.
 
Universal COVID-19 patient admission testing
"Are any of your healthcare systems performing universal COVID-19 testing (screening of asymptomatic patients) on admission or prior to all elective / non-urgent surgeries? If so, please share your successes and pitfalls." ~ Gonzalo Bearman MD, MPH, Chair of the Division of Infectious Diseases, Virginia Commonwealth University VCUHS Epidemiology and Infection Control, Richmond VA
 
COVID-19 readmissions
"Please comment on the above (proposed protocol) and share any alternative protocol you may have..." for identifying COVID-19 positive patients in EHR systems who, after discharge, may return to the hospital for reasons unrelated to COVID-19. ~Marci Drees, MD, MS, FACP, FSHEA, Chief Infection Prevention Officer, Hospital Epidemiologist, ChristianaCare
 
Dentistry opening
"Looking for opinions on what point and with what PPE does dentistry look at opening up?"
~Rebecca Shadowen MD, Infectious Diseases, Healthcare Epidemiology and Travel Medicine, Medical Director Med Center Health Physician Group, Bowling Green KY
Federal Policy Updates
H.R. 266 - Paycheck Protection Program and Health Care Enhancement Act 
On April 23, the House passed by a roll call vote (388-5-1) the Senate-approved Paycheck Protection Program and Health Care Enhancement Act (H.R. 266) – a $484 billion relief package to provide additional coronavirus relief to small business, health care providers, and hospitals, as well as provide funding to expand COVID-19 testing capacity. The bill now heads to the President's desk for his signature. The package includes: 
  • $75 billion for health care providers and hospitals;
  • $25 billion to expand COVID-19 testing capacity, including $11 billion for states, localities, territories, and tribes and $1 billion to cover testing for the uninsured;
  • Rural Health Clinics – The bill would direct $225 million of this funding for grants to rural health clinics to cover COVID-19 testing and related expenses, as well as building or construction of temporary structures, leasing of properties, and retrofitting facilities as necessary to support COVID-19 testing;
  • $1 billion for CDC-wide Activities and Program Support for surveillance, epidemiology, laboratory capacity expansion, contact tracing, public health data surveillance, information dissemination, and workforce supports;
  • $306 million of this funding to the National Institutes of Health (NIH) – National Cancer Institute to improve serological testing and associated technologies;
  • $500 million to the NIH National Institute of Biomedical Imaging and Bioengineering to support research for rapid testing of COVID-19.
  • $1 billion to the NIH Office of the Director to develop and implement COVID-19 testing and associated technologies, accelerate development of point of care and other rapid testing, and for partnerships with governmental and non-governmental entities.
  • BARDA – The bill would direct $1 billion of this funding to the Biomedical Advanced Research and Development Authority for research, development, manufacturing, production, and purchase of diagnostic, serologic, or other COVID-19 tests or related supplies.
  • $22 million of this funding to the Food and Drug Administration (FDA) to support activities associated with diagnostic, serological, antigen, and other tests, and related administrative activities.
  • Strategic National Stockpile – The bill would authorize the HHS Secretary to place COVID-tests and supplies purchased at the discretion of the Secretary with appropriated funds in the Strategic National Stockpile.
  • $6 million for the HHS Office of Inspector General to conduct oversight of COVID-19 related activities;
  • A provision requiring the HHS Secretary to issue reports on COVID-19 testing, cases, hospitalizations, and deaths, including demographic characteristics (due 21 days after enactment); and
  • A provision requiring the HHS Secretary to submit a national COVID-19 testing strategy to Congress (due 30 days after enactment). 
 
SBA Paycheck Protection Program (PPP) Interim Final Rule Contains Hospital Provision
The Small Business Administration (SBA) issued an interim final rule to supplement previously posted interim final rules on the Paycheck Protection Program (PPP) with additional guidance regarding promissory notes, authorizations, affiliation, and eligibility. Of note, the latest interim final rule allows certain public hospitals to apply for PPP loans. Specifically, "a hospital that that is otherwise eligible to receive a PPP loan as a business concern or nonprofit organization (described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code) shall not be rendered ineligible for a PPP loan due to ownership by a state or local government if the hospital receives less than 50% of its funding from state or local government sources, exclusive of Medicaid."
 
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