CLINICAL PATHWAY: CT Children’s ED and Inpatient COVID …...(see CAP Pathway), respiratory...
Transcript of CLINICAL PATHWAY: CT Children’s ED and Inpatient COVID …...(see CAP Pathway), respiratory...
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 Algorithm
LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
Ensure patient wears surgical mask.
Is patient immunocompromised including but not limited to: 60 days old,
receiving immunomodulators or chronic steroids, sickle cell anemia,
neutropenia and/or oncology patient?Consult on-duty ED attending
for guidance.
If clinically stable: if possible, place in zone B
After rooming, follow care below1
Does patient have moderate to severe respiratory distress within the past 72 hours?
ANDWithin the past 14 days, does the patient have:
A positive COVID-19+ test orclose contact2 with a COVID-19
positive person?
If patient has any one of the following: fever, mild respiratory symptoms, travel to high risk area, chilblains, loss of smell/taste, positive COVID-19 test or close contact2 with COVID-19 positive person Place in any available private room
If no COVID-19 risk factorsabove place in any available bed
After rooming, follow care below1
Place in Rooms 3 or 5 if possible; otherwise, any available private room (see COVID-19 ED Surge Plan)
Isolate patient 6 feet away from staff, other patients, and visitors
1Is the patient likely to require hospitalization?
YES
NO2Close Contact Risk
Living in the samehouse or visiting someone with confirmed/suspected COVID-19
Being within 6 feet of someone with confirmed/suspected COVID-19 for 15 minutes over a 24 hour period, starting 2 days prior to the diagnosis
Direct contact with infectious secretions with someone with confirmed COVID-19
Send COVID-19 testing only if clinically indicated.
DISCHARGE HOMEIf suspicion of COVID-19 infection: Refer to CDC s Guidance on Home Care (Not Requiring
Hospitalization)• Refer to COVID-19 Cardiology Return to Play Algorithm• Can offer telemedicine visit with CT Children s Infectious
Disease and Immunology [call CT Children s One Call 833-226-2362]
• Ensure patient and family is quarantined at home per CDC/DPH recommendations • CDC s Guidance for Preventing Spread of
COVID-19• CDC s Guidance for Discontinuing Home
Quarantine• CDC s Guidance for Discontinuing Home
Quarantine for Immunocompromised Individuals
Send COVID-19 test3 [reserve respiratory BIOFIRE for critically ill patients] o Appendix A Instructions for Sending COVID-19
Specimen
If suspicion of COVID-19 Infection:Evaluation and Initial Treatment:
Obtain baseline labs: o CBC with differential, chem 10, liver function
panel , blood gas with lactate, cortisol, fibrinogen, D-dimer, CRP, ESR, procalcitonin, LDH, ferritin, trigerlycerides, Hgb A1C in diabetic patients
o If suspected cardiac involvement: add troponin, NT-proBNP, CKMB
o If unable to obtain sufficient sample, prioritize based on clinical picture
When clinically indicated: consider portable CXR, EKG, UA-micro, urine culture
If signs of sepsis: use Sepsis Clinical Pathway If clinical picture consistent with bacterial pneumonia:
use CAP Clinical Pathway
If COVID-19 infection is not suspected: Standard care
Admit to inpatient floors See COVID-19 Inpatient Care on page 2
NO YES
YES
3UNIVERAL COVID-19 PCR TESTING FOR ALL ADMISSIONS:
See Appendix B: COVID-19Screening and Retesting Guidelines
ALL patients requiringhospital admission need a COVID-19 PCR test (with routine q2week screening on Mondays if prolonged admit)
Exceptions to testing:o Already tested within
the prior 72 hours o Positive test in the
prior 90 days COVID-19 test to be
ordered and sent in ED If LIAT COVID-19 testing
available: Utilize AppendixC: COVID-19 LIAT TestingWorkflowo Patient to stay in the
ED until LIAT results
If there is a cl inical suspicion for Multi-System Inflammatory
Syndrome in Children (MIS-C), please follow the MIS-C Clinical
Pathway.
Clinical suspicion would include:Fever 100.4 F for 24 hours AND any one of the following: GI: abdominal pain,
diarrhea, vomiting CV: chest pain, arrhythmia,
signs of shock, hypotension Mucocutaneous: rash, oral
changes, conjunctivit is, extremity swelling/peeling
Resp: cough, shortness of breath, difficulty breathing
Neuro: al tered mental status, headache, irr itabil ity
(Bolded symptoms are most common presenting symptoms)
NO
Is patient clinically unstable? Place in Room 1YES
NO
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
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©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 Algorithm
DISCHARGE CRITERIA/INSTRUCTIONS
• Clinically stable without supplemental O2 requirement, well hydrated without need for IVF• Offer telemedicine visit with CT Children s Infectious Disease and Immunology [call CT Children s One Call 833-226-2362] • Ensure appropriate follow up with PCP arranged• Refer to COVID-19 Cardiology Return to Play Algorithm• Ensure patient and family is quarantined at home per CDC/DPH recommendations
CDC s Guidance for Preventing Spread of COVID-19 CDC s Guidance for Discontinuing Home Quarantine CDC s Guidance for Discontinuing Home Quarantine for Immunocompromised Individuals
If patient requires CODE or MET: Use designated code cart Keep door closed if possible Use electronic communication devices as
able (code cart RN and Recorder RN) Only key personnel in room All personnel in room must wear COVID-
19 PPE
Initial Management(If not already completed in ED)
COVID testing: Send COVID-19 test4 (reserve respiratory BIOFIRE for critically ill patients)
o See Appendix A Instructions for Sending COVID-19 Specimeno See Appendix B: COVID-19 Screening and Retesting Guidelines for
screening (and retesting) guidelines If COVID-19 positive:
o If not already, move patient to Special Isolation Unito Providers to notify DPH (even if completed by lab): submit DPH
form onlineo Consult Infectious Diseaseo Inform primary attending
If initial COVID-19 test negative: see Appendix B: COVID-19 Screening and Retesting Guidelines for recommendations for repeat testing
Labs: If unable to obtain sufficient sample, prioritize based on clinical picture. Obtain baseline labs on admission:
o CBC with differential, chem 10, liver function panel , blood gas with lactate, cortisol, fibrinogen, D-dimer, CRP, ESR, procalcitonin, LDH, ferritin, trigerlycerides, Hgb A1C in diabetic patients
If suspected cardiac involvement: add troponin, NT-proBNP, CKMB If ferritin >500 mcg/ml: obtain cytokine panel (IL-6, IL-1, NK cell activity) Trend labs per primary team discretion
Studies: If clinically indicated, consider the following: portable CXR, EKG
Consults: Infectious Disease (required) Rheumatology, if suspected clinical/laboratory evidence of cytokine
storm syndrome (e.g. high fever, worsening coagulopathy, ARDS, elevated ferritin)
Cardiology, if suspected cardiac involvementNote: In order to conserve PPE, consultants will strongly consider waiving the physical examination. Nevertheless, a formal consult should be placed.
Treatment Considerations: Primarily supportive in nature with a focus on treatment of pneumonia
(see CAP Pathway), respiratory failure, ARDS, sepsis and septic shock(see Septic Shock Pathway)
Please utilize COVID-19 VTE algorithm to determine interventions toprevent or treat for thrombosis
If clinical suspicion of Multi-System Inflammatory Syndrome in Children (MIS-C), follow MIS-C Clinical Pathway
See Therapies for COVID-19 Pathway for medication considerations
Admit to Inpatient Units
Transfer and Admission of Patient Room based on Inpatient Med-Surg
COVID-19 Surge Guideline (Appendix D) or COVID-19 PICU Surge Plan
Refer to Transferring a COVID-19Patient (Appendix E)o Ensure receiving unit is ready
for patient arrival prior to transfer
o Transport patient in empty elevator
Visitor Guidelines Follow Visitor Guideline for
Inpatient Areas
General Considerations PPE and Respiratory Considerations
COVID-19 PPE• Please follow specific PPE
recommendations for specialized areaso See COVID-19 PPE policy on Intraneto If patient in PICU, see PICU specific
COVID-19 policy• Caregivers must mask when leaving patient
room, or when team member enters room • For quarantined patients (COVID negative,
exposed): special precautions x14 days; consider discontinuing if asymptomatic and no new risk factors
• For COVID positive patients: consider discontinuing special precautions (while continuing surgical mask, eye protection, gloves per COVID-19 PPE policy) when following criteria met:o If never symptomatic (and remains
asymptomatic): 10 days from first positive test (20 days if immunocompromised)
o If symptomatic: afebrile for 24 hours without fever-reducing medications, AND symptom improvement AND 10 days since symptoms first appeared (20 days if immunocompromised or was severely ill with COVID-19)
Evaluation and Treatment
Respiratory Considerations Must don N95 when caring for a patient
with a trach, unless COVID-19 PCR negative in prior 2 weeks with no new symptoms/risk factors - see AerosolizedProcedures (Appendix F)
See specific instructions for Respiratory Treatments
4COVID-19 PCR Screening See Appendix B: COVID-19
Screening and Retesting Guidelinesfor specific recommendations
ALL patients requiring hospital admission need a COVID-19 PCR test (with routine q2week screening on Mondays, if prolonged admission)
Exceptions to testing:o Already tested within the
prior 72 hours o Positive test in the prior 90
days Patients transferred, or admitted
directly to inpatient units will have COVID-19 test sent by inpatient floor staff (patient to be on SpecialPrecautions until result returns)
Patient and caregivers must remainconfined to room until COVID-19 PCR test results negative (caregivers may leave the hospital but must avoid use of shared spaces until test negative)
If screening COVID-19 PCR test is positive (or test is negative but with high clinical suspicion of COVID-19), patient will require transfer to the inpatient Special Isolation Unit (SIU)
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MD This pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.LAST UPDATED: 1.29.21
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 AlgorithmAppendix A: Instructions for Sending COVID-19 Specimen
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LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
INSTRUCTIONS FOR SENDING COVID-19 SPECIMEN
Hartford Hospital Specimen
• Specimens must be collected in a viral transport tubeo Both BIOFIRE and COVID-19 specimens may be sent with 1 single swab
(reserve respiratory BIOFIRE for critically ill patients)• Place COVID-19 sample in a green irreplaceable biohazard bag• Patient’s COVID-19 test requisition form (will have printed when COVID-19 test was
ordered)• Must hand carry sample to the HH Lab; DO NOT use the tube system• When walking samples to Hartford Hospital, the staff member will only need to wear
gloves for PPE. There is no need to don full PPE for sample transport.
LIAT Specimen
• Specimen must be collected in viral transport medium• Label sample with barcoded patient demographic label that includes: the initials of the
person collecting the sample, date and time of collection• Patient sample should be placed in a green irreplaceable biohazard bag• Must hand carry sample to COVID-19 specimen drop-off room (1C, room #1693) and fill
out the log• When walking samples to COVID-19 specimen drop-off room, the staff member will only
need to wear gloves for PPE. There is no need to don full PPE for sample transport.
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 AlgorithmAppendix B: Screening and Re-testing Guidelines
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LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
Screening for Admissions, Inpatients, and direct-to-OR from ED/Inpatient Units:
• ALL patients requiring hospital admission and urgent surgical procedures need ascreening COVID-19 PCR test
o If LIAT is available, utilize Appendix C: COVID-19 LIAT Testing Workflow• Exceptions to testing:
o Patient already tested within the prior 72 hours▪ EXCEPTION: if patient is newly symptomatic since the test, must retest
o Positive test result in the patient in the prior 90 days to admission▪ Patient is no longer infectious (standard precautions; does not need SIU
placement) when the following timelines are met:• If never symptomatic: 10 days from first positive test (20 days if
immunocompromised)• If initially symptomatic: afebrile for 24 hours without fever-reducing
medications, AND symptom improvement, AND 10 days sincesymptoms first appeared (20 days if immunocompromised or wasseverely ill with COVID-19)
▪ EXCEPTION: if patient is newly symptomatic within this 90 day period,must retest
• For ED patients requiring admission:o Screening test to be ordered and sent in the ED prior to transfer to floors or
surgeryo If LIAT is available, utilize Appendix C: COVID-19 LIAT Testing Workflow
▪ Patient to stay in the ED until LIAT results• For patients transferred or admitted directly to inpatient units:
o Screening test to be sent by inpatient floor staffo Patient will be on Special Precautions Isolation until COVID-19 PCR test results
negativeo Patients and caregivers must remain confined in room until COVID-19 PCR test
results negative (caregivers may leave the hospital but must avoid use of sharedspaces until test is negative)
• If requiring surgical procedure:o Screening test sent by ED or inpatient floor staff prior to procedure
• For long-term patients requiring prolonged hospitalization:o Send repeat COVID-19 PCR screening every other Mondayo See Appendix F: Aerosol Generating Procedures
• If initial COVID-19 PCR screen is POSITIVE (or test is negative but with high clinicalsuspicion of COVID-19):
o Patient will require transfer to the inpatient Special Isolation Unit (SIU)o Will require full utilization of COVID-19 PPE
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 AlgorithmAppendix B: Screening and Re-testing Guidelines
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LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
Recommendations for repeat COVID-19 testing:
• If initial COVID-19 screening test is positive:o There is no indication to retest within the following 90 days from first positive test
unless the patient becomes newly symptomatic▪ Patient is no longer infectious (standard precautions; does not need SIU
placement) when the following timelines are met:• If never symptomatic: 10 days from first positive test (20 days if
immunocompromised or was severely ill with COVID-19)• If symptomatic: afebrile for 24 hours without fever-reducing
medications, AND symptom improvement, AND 10 days sincesymptoms first appeared (20 days if immunocompromised or wasseverely ill with COVID-19)
• If initial COVID-19 screening test is negative:o If symptomatic with high clinical suspicion for COVID-19:
▪ Consider repeat COVID-19 testing (must have ≥24 hours between initialand repeat test)
▪ Continue isolation/COVID-19 PPE until repeat testing returns▪ If repeat testing is negative, patient likely negative for COVID-19 and no
further testing is required. Consider sending respiratory BIOFIREo If asymptomatic/respiratory BIOFIRE is negative, with low clinical suspicion for
COVID-19:▪ Likely negative for COVID-19 infection; repeat testing is not indicated
• For long-term patients requiring prolonged hospitalization:o Send repeat COVID-19 PCR screening every other Monday
• Special Circumstances:o May consider sending repeat COVID-19 PCR if:
▪ Needing transfer to another facility that requires a COVID-19 test within acertain time frame
▪ Patient is transferred to inpatient units without a prior COVID-19 test▪ Patient is needing COVID-19 testing pre-procedure▪ *Consider use of more rapid LIAT COVID-19 test when faster turn around
time is necessary
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 AlgorithmAppendix C: COVID-19 Liat Testing Workflow
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LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
Arrival to ED
Admit as Inpatient OR sent directly to OR
OR imminent inpatient psych admission?
Discharge to home
A COVID‐19 LIAT test may be ordered from the inpatient units in unique situations (e.g., patient transferred without prior COVID‐19 test, for psychiatric hospital placement, pre‐procedure)
Order:Rapid COVID/Flu (LIAT)
If clinically indicated:Rapid Flu/RSV (LIAT)
*select whom to route the result in the LIAT testorder
YES
Patient has COVID‐19 symptoms?
If clinically indicated, order:COVID/Flu (HHC)YES
Is the patient to return to the OR within 48 hours?
Order:COVID‐19 (HHC)
Order:Rapid COVID/Flu (LIAT)
*select whom to route the result in the LIAT test order
YESNO
YES
NO
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 AlgorithmAppendix D: Inpatient Med-Surg COVID-19 Surge Guideline
LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
COVID-19 Inpatient Med-Surg COVID-19 Surge Plan 1
Inpatient Medical Surgical COVID-19 Surge Plan Last edit: 12/9/20
• The SIU will remain on MS6 (6A) and will vary in size based on demand, with overflow to MS7 as outlined below• COVID positive patients, high risk PUIs* (only when LIAT test not available), and patients with probable diagnosis of MIS-C (see MIS-C Clinical Pathway)
will be placed in SIU • For patients who have known COVID-19 exposure but a negative initial COVID-19 PCR test, consider SIU placement or place on Special Precautions
o Consider repeat COVID-19 testing ≥24 hrs after initial testo If repeat testing is negative, patient likely negative for COVID-19
• Special Precautions for all patients in SIU• All patients to remain in room until COVID PCR results negative. Families to avoid public spaces until patient COVID PCR negative• Order of room use for non-COVID patients during inpatient surge: St. Mary’s (if meets clinical criteria), GSD, ED, PICU, treatment rooms, then playrooms
COVID-19 Surge Level Green [≤ 5 patients requiring SIU]
COVID-19 Surge Level Orange [6-10 patients requiring SIU]
COVID-19 Surge Level Red [>10 patients requiring SIU]
Rooms in order of use • [601-605]
o reserve negative pressure rooms 604 & 605 for aerosol generating procedures
Rooms in order of use • add 606-610
Rooms in order of use • flex to MS7, 7C (rooms 724-728)
Action Items • 604 & 605 PPE placed in anteroom• All other rooms place bedside table in hall
with PPE (gown, goggles/face shields)• Place trash can in hall• Place SIU signs in hall and special precaution
signs on patient doors • Extra Code Cart located in Pod A
Action Items • All other rooms place bedside table in hall
with PPE (gown, goggles/face shields)• Place trash can in halls• Ensure SIU and PPE signs are in
appropriate locations
Action Items • Open Command Center, if not already open
Communication • Visitor restrictions per protocol• Med Surg Directors update administration
on COVID volumes
Communication • Visitor restrictions per protocol• Med-Surg Directors update administration on
COVID volumes
Communication • Visitor restrictions per protocol• Med-Surg Directors update administration on
COVID volumes
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 AlgorithmAppendix D: Inpatient Med-Surg COVID-19 Surge Guideline
LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
COVID-19 Inpatient Med-Surg COVID-19 Surge Plan 2
Staffing • RN/PCA cohort in SIU• Standard MS6 Attending Coverage• Standard Resident coverage
Staffing • RN/PCA: cohort care in SIU• Standard MS6 Attending Coverage• Standard Resident coverage• RT: may need enhanced staffing
Staffing • RN/PCA: cohort care in SIU• Standard MS7 Attending Coverage• Standard Resident coverage• RT: may need enhanced staffing
•Supplies
• Ensure adequate PPE supply and storage• Utilize designated SIU PPE storage cabinet• Reprocess N95s per protocol
Supplies • Inform Supply Chain about heightened
need for PPE
Supplies • Inform Supply Chain about heightened
need for PPE
Testing • Universal testing for all patients admitted
to hospital and for patients going to the Operating Room
• No LIAT testing available:o High Risk PUI /COVID +/probable
MIS-C to SIU • LIAT testing available:
o COVID +/probable MIS-C patients in SIU
Testing • Universal testing for all patients admitted
to hospital and for patients going to the Operating Room
• No LIAT testing available:o High Risk PUI /COVID +/probable
MIS-C to SIU • LIAT testing available:
o COVID +/probable MIS-C patients in SIU
Testing • Universal testing for all patients admitted
to hospital and for patients going to theOperating Room
• No LIAT testing available:o High Risk PUI /COVID +/probable
MIS-C to SIU • LIAT testing available:
o COVID +/probable MIS-C patients in SIU
* PUI Definitions: • Person Under Investigation (PUI): An individual with symptoms of COVID-19 Infection or exposure to COVID-19 in the last 14 days
o Symptoms suggestive of COVID-19 infection: ▪ Fever without other probable cause, or ▪ Cough/shortness of breath, or ▪ New loss of taste or smell
o Exposure to COVID-19 in the prior 14 days, defined as one of the following: ▪ Close contact with a known positive case of COVID
• Close contact is defined as being within 6 feet of a COVID-19 infected person for a cumulative total of ≥15 minutes over a 24 hour period, starting from 2 days before diagnosis, or
▪ Recent travel to a location with a high level of SARS-CoV2 transmission (CT DPH Travel Advisory and CDC Travel), or ▪ Residence in an institution with an active cluster of COVID-like illness
• High Risk PUI: o Patients with current COVID-19 symptoms AND a known COVID-19 exposure
• Low Risk PUI: o Patients with current COVID-19 symptoms (NO known COVID-19 exposures)
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https://portal.ct.gov/Coronavirus/travelhttps://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 AlgorithmAppendix E: Transferring a COVID-19 Patient
LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
1
Process for Transferring a COVID-19 Patient
Patients with known or suspected COVID-19 can be transported safely between patient units by adhering to the following steps:
1. The receiving unit will indicate to the sending unit when the room andstaff are ready to accept the patient.
2. ED RN will give report to the receiving unit by phone.
3. ED RN will sanitize stretcher handrails and any other area with visiblesoil, with disinfectant wipes prior to leaving the ED.
4. Upon leaving the room, the patient will don a surgical mask and aclean sheet will be placed over the patient (to the chin) for transport.
5. If the ED RN is accompanying the patient to the new location, theymust remove their gloves and gown, wash their hands, and don cleangown and gloves. They may leave their N95 and eye protection onwithout change. If another team member is transporting the patientthey must wear appropriate PPE.
6. The patient must be transported directly to the receiving unit. Do notallow any visitors or other staff in the elevator with the patient. Onlyfamily members may accompany.
7. Receiving unit will be ready with PPE donned to receive the patient ina negative pressure room, or a standard room if no negative pressureroom is available.
8. A Special Precautions isolation sign must be placed on the door ofthe negative pressure room.
9. Once the patient is moved from the stretcher to the bed, remove thelinens from the ED stretcher and place in the linen hamper in theroom. The stretcher should be moved to the anteroom or hallway.
10. The team member will remove gown, gloves, and eye protection inthe room. The respirator/mask must be removed in the ante room orthe hallway if there is no ante room. Perform hand hygiene.
11. A new pair of clean gloves will be donned. Wipe the mattress andhandrails with a disinfectant wipe. Then transport the stretcher backto the original room in the ED for terminal cleaning of the entire room.
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THIS PATHWAY SERVES AS A GUIDE AND DOES NOT REPLACE CLINICAL JUDGMENT.
CLINICAL PATHWAY: CT Children’s ED and InpatientCOVID-19 AlgorithmAppendix F: Aerosol-Generating Procedures
LAST UPDATED: 1.29.21
©2019 Connecticut Children’s Medical Center. All rights reserved. 19-004
CONTACTS: MICHELE MCKEE, MD | CARLA PRUDEN, MD | ANAND SEKARAN, MD | JOHN SCHREIBER, MDThis pathway is subject to change, based on evolving recommendations from the CDC and CT DPH.
Aerosol Generating Procedures:
Updated 9/25/2020
Some procedures performed on patients who are potential or known positive for COVID-19 could generate infectious aerosols. In particular, procedures that are likely to induce coughing (e.g., sputum induction, open suctioning of airways) should be performed cautiously and avoided if possible.
Respiratory modalities in this category would include:
- IPPB- IPV- Cough assist- Vest- Nebulized medications- High flow nasal cannula (HFNC)- Non-invasive ventilation (BiPAP/CPAP) devices- Tracheostomy tube changes, floor patient with tracheostomy and open airway, etc (see PPE –
High Risk Scenarios) – Exception: if a patient with a tracheostomy has been admitted and hashad a negative COVID-19 PCR test in the prior 2 weeks with no new symptoms or other COVID-19risk factors, an N-95 mask is not required
Though higher risk, health care providers may still need to perform these procedures if it is clinically required. It is imperative to take the necessary PPE precautions when performing these aerosolizing procedures (PPE policy High Risk Scenarios). In addition:
- If performed, these procedures should take place in a negative pressure room when possible- Limit the number of health care providers present during these aerosol generating procedures
to only those essential for patient care and procedural support- Clean and disinfect procedure room surfaces promptly per CDC recommendations
Reference: CDC Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.
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