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What method of hand hygiene is recommended for healthcare personnel in response to COVID-2019?The CDC continues to recommend the use of alcohol-based hand rub (ABHR) as the primary method for hand hygiene in most clinical situations1.Hands should be washed for at least 20 seconds with soap and water when visibly soiled, before eating, and after using the restroom.Are benzalkonium chloride-containing hand rub products an acceptable alternative to ABHR for COVID-19?CDC does not have a recommended alternative to hand rub products with greater than 60% ethanol or 70% isopropanol as active ingredients.Benzalkonium chloride, along with both ethanol and isopropanol, is deemed eligible by FDA for use in the formulation of healthcare personnel hand rubs2. ??However, available evidence indicates benzalkonium chloride has less reliable activity against coronavirus than either of the alcohols3.How should healthcare organizations respond to severe shortages of ABHR?? (SEE ATTACHED FDA & WHO GUIDANCE)Healthcare organizations that encounter severe shortages of ABHR (and have exhausted supply chain access to efficacious products) may consider local production of formulations as described by the FDA?Policy for Compounding of Certain Alcohol-Based Hand Sanitizer Products. ??This policy remains in effect through April 30, 2020.Formulations included in the FDA guidance are consistent with World Health Organization production guidance. These locally produced products are intended for routine healthcare personnel hand cleaning, must not contain active ingredients other than those specified in the FDA guidance, and should not take the place of other regulated skin antiseptics (e.g. surgical hand rub). To avoid contamination with spore-forming organisms, WHO formulations require a 72-hour post-production quarantine. Organizations should revert to the use of commercially produced, FDA-approved product once such supplies again become available.Can healthcare facilities substitute unformulated ethanol in concentrations greater than 60% or isopropanol greater than 70% for use as alcohol-based hand rub?? Given the drying effect of alcohols and the importance of maintaining skin integrity of healthcare personnel with their need to perform hand hygiene frequently, alcohols should not be used unless properly formulated with emollients.Caring for Someone at Home: people who get sick with COVID-19 will have only mild illness and should recover at home. (If they are high risk population – seek professional care as soon as symptoms start)Care at home can help stop the spread of COVID-19 and help protect people who are at risk for getting seriously ill from COVID-19.If you are caring for someone at home: ?monitor for emergency signs: Difficulty breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face. (Not an all inclusice list. Consult medical provider for other symptoms that are severe or concerning. ?prevent the spread of germs: Stay in separate room away from people, use separate bathroom, avoid sharing any items, have them wear a facemask when people are around, if they can’t wear a facemask than the cg should wear one while around the pt. Clean hands per CDC recommendations, avoid touching your face, clean all surgaces that are touched aften per CDC recommendation, wear disposable gloves to do their laundry and keep soiled items away from your body, avoid unnecessary visitors.?treat symptoms: Increase fluids to stay hydrated and rest at home, over-the-counter medicines may help with symptoms which usualy last a few days.when to end home isolation: NOT TESTED – No fever for at least 72 hours without medicine to help reduce fever, AND other symptoms have improved (cough, SOB), AND at least 7 days have passed since their symptoms first appeared.? IF TESTED: No longer have a fever without the use of medicine to reduce fever, AND other symptoms have improved (cough, SOB), AND they receive 2 negative test in a row 24 hours apart. What People with HIV should know: ? The link will take you to the page with multiple Q&A.The guidance is similar to all high risk population. Some types of HIV medicine are being evaluated in clinical trials to treat COVID-19. CDC recommends that people with HIV should not switch their HIV medicine in an attempt to prevent or treat COVID-19.Minimizing stigma and misinformation about COVID-19 is very important. People with HIV have lived experience in dealing with stigma and can be allies in preventing COVID-19 stigma. Learn how you can reduce stigma and help prevent the spread of rumors?about COVID-19.Stress and Coping:? ?? people are at higher risk for severe illness from COVID-19 which may result in increased stress during crisis. ?(8 out of 10 deaths in the US have been in adults 65 yo and older)Fear and anxiety about the pandemix can be overwhelming and cause strong emotions.Take breaks from watching, reading, or listening to news stories and social media.? Hearing about the pandemic repeatedly can be upsetting.Take care of your body. Take deep breaths, stretch, or mediatate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.Make time to unwind. Try to do some other activities you enhoy.Connect with others. Talk with people you trust about your concers and how you are feeling.Call your healthcare provider if stress gets in the way of your daily activities for several days in a row.**If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others, call:? 911Substance Abuse and Mental Health Services Administration’s Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)LINK TO THE FOLLOWING CDC POSTERS AVAILABLE IN MULTIPLE LANGUAGES:? ? Alert: Protect Yourself and OthersTraveler Health Alert NoticeHealth Alert: For Departing TravelersHealth Alert: For All TravelersStop the Spread of Germs PosterStop of Coronavirus Disease 2019 PosterHand Hygiene update sent earlier in an urgent email – Hand sanitizer shortage guidance?? Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. This first preliminary description of outcomes among patients with COVID-19 in the United States indicates that fatality was highest in persons aged ≥85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years, <1% among persons aged 20–54 years, and no fatalities among persons aged ≤19 years.2. Approximately 49 million U.S. persons are aged ≥65 years (9), and many of these adults, who are at risk for severe COVID-19–associated illness, might depend on services and support to maintain their health and independence. To prepare for potential COVID-19 illness among persons at high risk, family members and caregivers of older adults should know what medications they are taking and ensure that food and required medical supplies are available. Long-term care facilities should be particularly vigilant to prevent the introduction and spread of COVID-19. In addition, clinicians who care for adults should be aware that COVID-19 can result in severe disease among persons of all ages. Persons with suspected or confirmed COVID-19 should monitor their symptoms and call their provider for guidance if symptoms worsen or seek emergency care for persistent severe symptoms.COVID-19 in LTC facility – King County, Washington, 2/27 to 3/9:. The introduction of COVID-19 into a LTC residential facility resulted in cases among 81 residents, 34 staff members, and 14 visitors; 23 persons died.? Limitations in effective infection control and prevention and staff members working in multiple facilities contributed to intra- and interfacility spread. 2. LTC facilities should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members, restricting visitation except in compassionate care situations, ensuring early recognition of potentially infected patients, and implementing appropriate infection control members.3. These findings demonstrate that outbreaks of COVID-19 in long-term care facilities can have a critical impact on vulnerable older adults.4. The findings in this report suggest that once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors. In the context of rapidly escalating COVID-19 outbreaks in much of the United States, it is critical that long-term care facilities implement active measures to prevent introduction of COVID-19. Measures to consider include identifying and excluding symptomatic staff members, restricting visitation except in compassionate care situations, and strengthening infection prevention and control guidance and adherence. Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to COVID-19. The underlying health conditions and advanced age of many long-term care facility residents and the shared location of patients in one facility places these persons at risk for severe morbidity and death. Rapid and sustained public health interventions focusing on surveillance, infection control, and mitigation efforts are resource-intensive but are critical to curtailing COVID-19 transmission and decreasing the impact on vulnerable populations, such as residents of long-term care facilities, and the community at large. As this pandemic expands, continued implementation of public health measures targeting vulnerable populations such as residents of long-term care facilities and health care personnel will be critical. As public health measures are continually implemented, public information needs will only grow. To provide information for patients and families as well as communicate more broadly to all stakeholders, public officials and other community leaders need to work together to encourage everyone to understand and adhere to recommended guidelines to manage this outbreak.People with Asthma and COVID-19:CDC is not sure yet if this population is at higher risk of getting COVID-19, but if they do get infected they may be at higher risk of getting very sick. CDC Recommendation for this population:Stock up on supplies (extra necessary medications, over-the-counter medication and supplies, household items and groceries you need to stay home for a prolonged period of time. (30 day supply)Practice social distancing.Follow CDC handwashing and surface disinfecting recommendations.Avoid crowds, cruise travel, and nonessential air travel.During a COVID-19 outbreak in your community, stay home as much as possible.If someone in your home is sick, have them stay away from the rest of the household.Avoid sharing personal household items such as cups and towels.Take your asthma medication exactly as prescribed.? Make sure you know how to use your inhaler. (See proper inhaler use pdf.)Avoid your asthma triggers.If you have symptoms, contact your health care provider.COVID-19? and travel in the US:?? has been reported in all 50 states and some areas are experiencing community spread of the disease.? Crowded travel settings may increase chances of getting COVID-19 if there are other travelers with the infection.? THINGS TO CONSIDER BEFORE TRAVEL:Is COVID-19 spreading in the area where you’re going?? If COVID-19 is spreading at your destination, but not where you live, you may be more likely to get infected if you travel there than if you stay home. Will you or your travel companion be in close contact with others during your trip?? Your risk of exposure to COVID-19 may increase in crowded settings, particularly closed-in settings with little air circulation. (Like - Conferences, concerts, sporting events, religious gatherings, movie theatres, shopping malls, buses, metro, trains, etc.)Are you or your travel companion more likely to get severe illness if you get COVID-19?? Any traveler at higher risk (older adults or anyone with serious chronic medical conditions like heart and lung disease, or diabetes) avoid all cruise travel and nonessential air travel. Do you have a plan for taking time off if you get sick with COVID-19?? If you have contact with someone with COVID-19 during travel, you may be asked to stay home to self-monitor and avoid contact with others for up to 14 days after travel. If you become sick with COVID-19, you will be unable to go to work or school until you’re considered noninfectious. You will also be asked to avoid contact with others during this period of infectiousness. ?Do you live with someone who is older or has a serious, chronic medical condition? Your household contacts may be at risk of infection and the high risk population are at a higher risk for severe illness from COVID-19.Is COVID-19 spreading where I live when I return from travel?? Consider the risk of passing COVID-19 to others during travel. If your symptoms are mild or you don’t have a fever, you may not realize you are infectious. Depending on your unique circumstances, you may choose to delay or cancel your plans.? If you do decide to travel, be sure to take steps to help prevent getting and spreading COVID-19 and other respiratory diseases during travel. COVID-19 Travel Recommendations by Country: 3 With restrictions on US entry – China, Iran, Most European Countries, UK, and IrelandLevel 3 Without restrictions on US entry – Malaysia and South KoreaLevel 2 – Global Outbreak Notice – CDC recommends that older adults and people of any age with serious chronic medical conditions should consider postponing nonessential travel to most global destinations.CDC recommends that travelers defer?all cruise?travel worldwide.?See attached resource for patient information at home - has other PDF forms for clinics.See attached PDF for Healthcare Facilities – Strategies for optimizing the supply of N95 Respirators during COVID-19 response (this was sent in the urgent email earlier today) ................
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