April 13: Daily COVID-19 UPDATE

Monday, April 13, 2020, 6:30 p.m.

NEW TODAY: Here’s the latest information about Michigan Medicine’s management of the COVID-19 pandemic:

• DAILY PATIENT STATS
• DAILY TEAM MEMBER TESTING STATS
• CRITICAL CARE UPDATES
• HIGH RELIABILITY RESOURCES
• UH PACU CLOSURE
• PERSONAL PPE POLICY
• REDPLOYMENT PROCESS UPDATE
• TOWN HALL FAQs
• SHARE YOUR STORY

DAILY PATIENT STATS

Today’s census for COVID-19 inpatients and those patients under investigation (PUI) are noted below: 

Discharges: 203 total COVID-19 discharges to date, 5 in the last 24 hours.

DAILY TEAM MEMBER TESTING STATS*

* Data from 3/10 through 4/13. Please note: Monday’s data captures the number of employees who were previously tested outside of Michigan Medicine and who were not included in our daily stats until today.  We were aware of these cases but because of a manual data process, some employee data was not captured in previous reports. These numbers do not reflect a recent increase in actual numbers of COVID-19 positive employees. Most of these cases occurred two weeks ago. For context, 26 employees have tested positive over the past seven days.

CRITICAL CARE UPDATES

Michigan Medicine has updated critical care guidelines in the following areas:

• Michigan Medicine COVID?19 Adult Critical Care Consensus Recommendations
• Policy and Protocol for obtaining Compression Duplex ultrasonography for diagnosis of VTE during the COVID?19 Pandemic
  • COVID?19 Algorithm for PE Assessment
  • COVID?19 Algorithm for DVT Assessment
• Overview of ARDS Ventilator Strategies for COVID?19
• Michigan Medicine Tracheostomy Guidelines in COVID?19 Era
• Use of Sedative, Analgesic and Neuromuscular Blocking Agents in the Intensive Care Unit During the Novel 2019 Coronavirus Pandemic – Michigan Medicine Guidelines

The new guidelines are posted at Critical Care Protocols for COVID-19 Patients.

HIGH RELIABILITY RESOURCES

While in-person training for HRO universal skills training is on hold during the COVID crisis, the Office of Patient Safety has created a Universal Skills one page reference guide at http://www.med.umich.edu/i/covid19-careplan/pdf/providingcare/covid-critical-care-protocols-v2.pdf.

UH PACU-ICU CLOSURE

Given our current and expected COVID ICU demand, our expanded COVID ICU capacity (including within C&W 12 West) and our ability to manage the expected patient volume within this ICU complement, we have made a decision to close the UH PACU-ICU effective immediately.  We will work to convert the UH PACU back to the usual recovery space over the coming week. 

We are evaluating the timing of when we might be able to expand our non-COVID surgical activity; preparing the PACU for this future growth will be critical.

Thanks to all of the teams who worked quickly to set up and deliver care to patients within the PACU.

PERSONAL PPE POLICY

The Joint Commission and the American Medical Association have issued statements regarding health care workers wearing their own PPE.  Both organizations support this only when healthcare organizations cannot supply the necessary equipment for employees to protect themselves from risk of infection. 

Because Michigan Medicine does have adequate supply of standard medical grade PPE that is safe, including adequate supplies of N95 masks, we will not permit use of equipment brought in from home.  Personal masks brought from home cannot be guaranteed to meet the protection provided by hospital supplied masks.  There are concerns that some sources of masks may be counterfeit or not meet protective standards.  In addition, unless individual mask brands and models are fit tested, N-95 masks do not provide the appropriate level of respiratory protection.  Please see the links below to support the decisions and policies for decision making to protect our employees from risk of infection.

• Joint Commission Statement on Use of Face Masks Brought From Home
• FAQs in Response to The Joint Commission’s Position Statement on Use of Face Masks Brought from Home
• AMA statement on health care workforce using their own PPE

REDPLOYMENT PROCESS UPDATE

As of April 1, Michigan Medicine has reached an “all hands on deck” mandatory redeployment state. Several groups, including Human Resources, UMMG, Nursing, OCA, and others are working through redeployment and reassignment for faculty and staff. Those employees working in UMMG, Nursing, and our Faculty and Advanced Practice Providers should continue to work with their leadership to use the internal process established for your area. Any employee outside of these areas who has not yet completed the redeployment request form should do so now. Manager approval is needed.

We continue to assess needs in both clinical and non-clinical roles, and appreciate everyone’s patience. Once you complete the redeployment request form, and an assignment is available, you will be notified by email.

Redeployment is considered mandatory for all employees and refusal to work may result in disciplinary action.

Any questions about redeployment, including about necessary accommodations, should be emailed to HR-Pandemic-Staff@med.umich.edu. Additional information about redeployment is in the HR FAQs.

TOWN HALL FAQs

General Operations

Is the hospital following OSHA guidance for respirator use for COVID-19 patient care?

The Occupational Safety and Health Administration does not call for respirator use for care of all COVID-19 patients. Learn more about OSHA’s guidance here. Our PPE policy is also consistent with recommendations from the World Health Organization and the Centers for Disease Control.

Do you expect a spike in new cases once the stay-at-home order is lifted?  

We don’t have enough information to accurately predict what will happen when social distancing restrictions are lifted.  Several public health approaches will need to be in place to limit a spike in new cases, including testing all people with symptoms, comprehensive contact tracing and isolation of sick and exposed persons.  Michigan Medicine will need to be prepared for continuous care of patients with COVID-19 as well as a possible second surge. 

What should I do if an employee under my supervision or co-worker is diagnosed with COVID-19?

First, remember that the employee will appreciate hearing your support while they recover from the illness. You should clarify whether they have received any specific guidance from Occupational Health Services related to others in the workplace. Next, you can anticipate that other employees may have heard about, or suspect that, someone is out sick with the COVID-19 related illness. They may understandably have concern for the colleague as well as concern over a potential exposure risk to themselves or others.

You may acknowledge that there is an individual in the unit who has tested positive for COVID-19 without identifying the individual.  Please reach out to your Human Resource business partner for letter templates. If you are in a healthcare setting, additional requirements to assess risk may apply, and you should follow OHS reporting procedures.  Employees may continue to work if they are asymptomatic.

Supervisors looking for guidance on whether additional cleaning is necessary in the space may contact the Facilities Service Center at: EHS-Covid-19-Reporting@umich.edu. Michigan Medicine healthcare entities can contact the Michigan Medicine C-L-E-A-N line (734-23CLEAN).

Some patients are being discharged to long-term care facilities. Are they being tested prior to transfer to be certain they are no longer testing positive for the virus?

Michigan Medicine is working closely with local long term care facilities to assure that appropriate isolation occurs after COVID-19 patients are discharged.  LTCFs may follow a symptom based strategy or a test based strategy to determine when isolation may be lifted for COVID patients. When required by LTCFs, patients with COVID are being tested prior to discharge to determine if they have cleared the virus based on PCR testing.

Nursing

Some general care floors are not benefitting from the new staffing model. Can they return to the way they were staffing before? 

We cannot completely go back to regular staffing as many moderate care and telemetry nurses are supporting ICU care where the critical needs are due to ICU expansion. We will eventually get back to our staffing plan. Clinical directors, supervisors, and ACNOs will evaluate staffing, census, and acuity of patients on the general care floors as well as ICUs and make adjustments based on the availability of the staffing pool. We will add staff support to the model if we can, but it may require nurses to assist other units that have higher needs.

Finances

What is the source of funding for the COVID-related PTO banks? Does it come out of each unit’s budget or a central budget?

All expenses related to the use of these programs should be charged to the local unit budgets, no different from our regular PTO programs.

That said, we have put mechanisms in place (namely the use of the PAN time tracking code) that allows all units to identify the amount of time that has been incurred under these programs.

Human Resources

Can you clarify who is eligible for the 120 hours of paid time off?

The additional 120 hours, special-use PTO bank is available for full-time employees who need to isolate as a result of contracting COVID-19 while providing direct care for confirmed COVID-19 patients. This special bank of time is prorated for part time and temporary employees. Please consult with your supervisor or human resources representative if you have questions about eligibility.

PPE

Can something be done to help with skin irritation or breakouts from masks, especially behind the ears?

There are several strategies to help with irritation related to prolonged use of earloop masks.  Healthcare workers can use topical barriers such as Vaseline at the sites of skin irritation.  Some healthcare workers have also used elastic extenders between the loops instead of placing them behind their ears. 

Can you release safety data and studies on the recycled n95s? Have they been tested in real-world circumstances for cross contamination and safety?

The CDC recently compiled and summarized published data on PPE decontamination methods. The report shows ultraviolet germicidal irradiation (UVGI), vaporous hydrogen peroxide (VHP), and moist heat methods are most promising for filtering face piece respirator (FFR) decontamination and reuse.  UVGI-treated N95s not only passed FFR filtration performance testing, but had a 90-100% passing rate for fit and performance after three cycles, as well as an antimicrobial decontamination efficacy range from 99.9% to greater than 99.999% for all tested viruses including SARS-CoV.

At Michigan Medicine, we are using a combination of treatment with UVGI and heat.  Under this decontamination protocol, our researchers found N95s to pass filtration and fit testing for at least 10 cycles of disinfection as well as achieving >99.8% inactivation of a surrogate influenza virus. As always, if any N95 cannot pass a seal check or is compromised, it should not be used.

SHARE YOUR STORY

As Michigan Medicine rises to the extremely difficult challenges of COVID-19, share your experiences during this unprecedented pandemic by sending a story, photo, video or audio file to headlines@med.umich.edu. We are hoping to archive this time in history and to help us reflect on our resiliency.

Team members can also recognize colleagues by posting a message of gratitude and encouragement on social media using #HailToTheFrontline. Alternatively, messages can up uploaded directly at www.UofMHealth.org/frontline by clicking on “Add your message of encouragement” or sent to headlines@med.umich.edu to be posted on the Headlines Thank You Corner.

Still have questions?

We are also posting all daily bulletins and policies on Michigan Medicine Headlines at https://mmheadlines.org/covid-19-updates/.  Please bookmark that site and refer to it throughout the day for the most up-to-date information. An FAQ for staff is also posted and updated frequently.

If you still can’t find what you’re looking for on these web pages, please email coronavirus-info@med.umich.edu and your question will be answered as quickly as possible.  Do not use this email for sharing patient health information.

Jeffrey Desmond, M.D.
Chief Medical Officer