KHN Designated Care Unit Standard Operating Procedures

KHN Designated Care Unit Standard Operating Procedures  

The goal of the designated care units is to group like patient populations for infection control care delivery.  

The Designated Care Units  

• Five (5) local  hospitals have designated care units: 
  • Kettering Medical Center: 5 Northwest (primary 15 beds) and 5 South (secondary 25 beds) 
  • Sycamore Medical Center: Unit 3 West (32 beds) 
  • Grandview Hospital Medical Center: 4 West (primary 24 beds) and 5 West (secondary 24 beds) 
  • Soin Medical Center: 3rd floor (30 beds)
  • Fort Hamilton Hospital: 4 West (primary 20 beds) and 4 Main (secondary 37 beds secondary) 

Bed Placement Process

1. Campus contacts the NOCC  
2. NOCC places the patient in appropriate designated unit per NOCC protocol
3. Private room for all patients
4. Isolation: Standard, Droplet, and Contact precautions = Surgical Mask, Goggles, Gown, Gloves for all patients
5. Patients undergoing aerosol generating procedures or who are intubated
   • Airborne with Contact precautions = PAPR or N95 respirator/goggles, Gown, Gloves
   • Patient should be placed in a negative pressure room
     • If negative pressure room not available, keep door closed

Equipment/items to prepare the unit

• PAPRs  
• N95 Emergency Intubation Bags (aka Go-Bags) 
• Surgical Masks  
• Goggles/eye protection
• General care supplies  
• Disposable stethoscopes  
• KHN supplied scrubs  
• Change trash to Red Biohazard Bags 
• KHN Marketing approved signage
• Staff may not bring in their own PPE, must use PPE provided by KHN that has been inspected for quality 
• Reusable patient care equipment must be wiped down with purple top Sani Wipe before use for another patient 
• Tube system: No biologic samples (blood, urine, swabs, etc.) are to be sent via tube. 

Staffing assignments  

• Every reasonable accommodation will be made for staff who are considered to be high risk to not work on a designated care unit.  
• Examples include: 
  • Pregnancy 
  • Immunocompromised  
  • Persons who have serious underlying medical conditions like: 
    • Heart disease
    • Diabetes 
    • Lung disease 

Education for care team  

• Review CDC Checklist for Donning and Doffing PPE  
• HealthStream’s for PAPR, N95, and Airborne with Contact need to be completed
• When an employee is donning and doffing PPE for the first time, a second observer is needed to validate the correct order 
• Video how to keep mask clean: https://youtu.be/k7b_nhTtN4M 
• Video on how to self-check a N95 Respirator: https://www.youtube.com/watch?v=BnXN1OD6VRw

PPE: When and what  to wear 

• Hallways/nurses stations:
  • If you are on the unit and in the hallway/nurses’ station, PPE is not required 
  • Surgical masks and goggles can be worn between patient rooms
    • Recommendation is to don your mask once you start patient care for the day. Wear your mask as long as possible.  
    • If you touch your mask or goggles, make sure your clean your hands before and after  
    • When you eat: Doff your mask by the straps, grasp mask on inside, fold in half with inside of mask facing outward, place in brown paper when not in use, see video: https://youtu.be/k7b_nhTtN4M
• Patient room/care for non-intubated patients with no aerosolized treatments anticipated  
  • Droplet precautions with contact is required
  • PPE = surgical mask, goggles, gown, gloves
• Patient room/care during aerosolized treatments (such as trach suctioning, BiPAP, nebulized treatments, intubations, high-flow O2, etc.): 
  • Airborne with contact precautions is required.
  • PPE = PAPR, Gown, Gloves
• Patient room/care during intubation and while patient remains on a ventilator
  • Airborne with contact precautions is required.
  • PPE during emergency= “Covid-19 Emergency N95 Intubation Bag”
  • PPE= PAPR or N95/Goggles, Gown, Gloves
    • Person intubating receives the N95 and goggles or a PAPR
    • Additional healthcare personnel wear a PAPR
    • If possible, place in negative pressure room or keep door closed.

PPE: Donning These requirements apply to all staff entering the room of a patient. 

The following PPE is required to be donned prior to entering the patient room. 

• Hand Hygiene
  • Hand Hygiene is the single most important means of preventing the spread of infection. Hands must be disinfected with an alcohol-based hand rub before and after providing care.

• Respiratory protection:
  • All staff must wear respiratory protection when caring for patients. The type of protection is dependent on the patient’s care
  • One (1) mask per caregiver per shift unless replacement is needed due to visible contamination or mask becomes moist
  • Surgical Mask: Droplet precautions
    • Patient should always wear a surgical mask if able to tolerate
    • All staff must wear a surgical mask unless during an intubation or aerosolizing procedure
    • Once staff place their mask on, it can be worn in multiple patient rooms
    • Remove during eating/drinking
    • Doff your mask by the straps, grasp mask on inside, fold in half with inside of mask facing outward, place in brown paper when not in use, see video: https://youtu.be/k7b_nhTtN4M
  • N95 Respirator with goggles: (for emergency intubation) – Airborne Precautions
    • A fit seal check should be performed before use
    • Store in brown paper bag between use
  • PAPRs: Airborne Precautions
    • All equipment (including disposable hoods) are to be wiped down with purple top Sani Wipes after use
• Goggles: (use with surgical or N95 mask)
  • All staff must wear goggles or face shield to protect mucous membranes from exposure due to splash or potential for contamination of eyes, nose or mouth 
  • These are to be wiped down between uses with the purple top Sani Wipes and returned to storage for next shift. 
  • If you wear glasses- you still need to wear goggles
• Gowns:
  • A clean, nonsterile, isolation gown must be worn
  • Ensure that gown is tied in the back and provides full frontal coverage
  • KMC has washable gowns. Please place in laundry bags.  All other sites have one (1) time use gowns to dispose of in Red Biohazard Bags
• Gloves:
  • All staff must wear clean, nonsterile gloves
  • Gloves must be pulled over the sleeves/cuff of gown
• Hand Hygiene:
  • Hand Hygiene is the single most important means of preventing the spread of infection. Hands must be disinfected with an alcohol-based hand rub before and after providing care that involves touching the patient or the patient equipment/belongings

Staffing and PPE guidelines – Please see above PPE requirements when entering the patient’s room

• Nursing
  • RN 1:3 Patients and 1 NA/HUC who is telemetry competent
  • Nursing needs to receive training for lab draws and IV starts if not competent
  • Nursing is not recommended to leave the unit during their shift unless transporting for a procedure or otherwise authorized
  • Don hospital provided scrubs upon entry to designated unit; doff scrubs upon exit from designated unit. Donning and doffing areas will be provided. 
• Attending Physicians/APPs
  • Wear normal KHN approved uniform
  • Wear appropriate PPE per patient needs when providing patient care
  • Rounding patterns TBD
• Specialist Physicians/APPs
  • Touch base with nursing on unit to confirm isolation procedures
  • Wear normal KHN approved uniform
  • Wear appropriate PPE per patient needs when providing patient care
• Respiratory
  • Wear normal KHN approved uniform unless you are designated (i.e. spending your entire shift within the unit and not caring for patients outside the unit) to the unit for your entire shift. If designated, change into hospital provided scrubs
  • Wear appropriate PPE per patient needs when providing patient care
  • Outside the patient rooms, no PPE is necessary
  • Grandview– May continue to draw ABGs
    • Bring a runner to obtain specimen at the door- only need gloves
• Care Management
  • Wear normal KHN approved uniform
  • Work with nurse and physician to help facilitate communication when possible
  • If specific care management-to-patient discussion needs to occur; use the telephone to facilitate the conversation
  • Outside the patient rooms, no PPE is necessary
• Lab/phlebotomy
  • Wear normal KHN approved uniform
  • Wear appropriate PPE per patient needs when providing patient care
  • Outside the patient rooms, no PPE is necessary
• Security
  • Wear normal KHN approved uniform
  • Wear appropriate PPE per patient needs
  • Outside the patient rooms, no PPE is necessary
• Pharmacy
  • Wear normal KHN approved uniform
  • Wear appropriate PPE per patient needs when providing patient care
  • Outside the patient rooms, no PPE is necessary
• Supply Chain
  • Wear normal KHN approved uniform
  • Outside the patient rooms, no PPE is necessary
• EVS
  • Wear normal KHN approved uniform
  • When not working in a patient care room, then no PPE is necessary
  • When cleaning in a patient care room
    • Ask the nurse to determine which isolation precautions applies to the patient
      • Airborne with Contact PPE= PAPR, Gown, Gloves
      • Droplet with Contact PPE= Gown, Gloves, Mask, Goggles
  • Scheduled cleaning in a patient care room with nurse directed PPE
  • Terminal Cleaning PPE= Gown, Gloves, Mask, Goggles
  • Clean with standard hospital disinfectant
  • Nursing will call for visible soiling of environment cleaning as needed
  • Waste cans are to have Red Biohazard Bag
    • Nurse will bag and close trash, take it to Soiled Utility Room and call EVS for pick-up when the bin is 2/3 full.
    • EVS to wipe bins with purple top Sani Wipes, wait two (2) minutes and prepare to transport
    • When transporting bin outside the unit, steps must be taken to prevent contamination of objects and surfaces encountered during the transport
• Therapy
  • Wear normal KHN approved uniform if you will not be working on the designated unit for your entire shift.
  • If you will be working on the designated unit for your entire shift, change into hospital provided scrubs. Donn hospital provided scrubs upon entry to designated unit; doff scrubs upon exit from designated unit. Donning and doffing areas will be provided. 
  • Outside the patient rooms, no PPE is necessary
    • Ask the nurse to determine which isolation precautions applies to the patient
      • Airborne with Contact PPE= PAPR, Gown, Gloves
      • Droplet with Contact PPE= Gown, Gloves, Mask, Goggles
• Nutrition  
  • Wear normal KHN approved uniform
  • Deliver meals to nurse’s station, no PPE necessary
• IV pump management process
  • Unit will designate an employee to communicate equipment needs via phone call to Pump Management team. Equipment will be brought to the outside of the unit, unit called informing them the delivery has arrived and then leave the area.
  • The unit employee will retrieve the equipment and stock PAR for the location.
  • The isolated unit will also be responsible for collecting the soiled equipment, placing it on a cart, covering with a sheet, and moving outside of the unit to be retrieved.
  • Once the soiled equipment is outside the unit, a phone call should be made to notify the Pump Management team for retrieval.
  • All equipment will be treated as potential biohazard.

Transporting a patient for testing/diagnostic areas

• Call the testing/diagnostic department prior to transporting the patient, informing them of Droplet precautions with contact = Surgical Mask, Goggles, Gown, Gloves
• RN will transport the patient to testing/ diagnostic
  • PPE for transporting
    • Droplet precautions with contact= Surgical Mask, Goggles, Gown, Gloves
  • Request a person to accompany the RN for touching surfaces, i.e., elevator buttons, doors, etc.
• PPE for receiving testing/diagnostic employee
  • Droplet precautions with contact= Surgical Mask, Goggles, Gown, Gloves
• PPE for the patient
  • Surgical Mask during transport
• Cleaning process for testing/diagnostic areas after the patient leaves: follow standard cleaning protocol Droplet and Contact Precautions

Criteria for transferring out of designated units

• Transfer to higher level of care
• Must remain on designated unit until COVID-19 test resulted negative or stable for discharge home to await results

What discharge instructions do I provide the patient?

• Normal AVS process
• The link for the CDC “What to do if you are sick with coronavirus 2019?” (www.cdc.gov/COVID19) which has been embedded for all AVSs
• Please print the CDC link and review with patient along with your normal discharge procedures
• There are Epic smart phrases coming Monday 3/23/20

Patients leaving AMA

In the event a patient wants to leave AMA, use your chain of command and call the incident command center at X41927 so we can follow up with the local health department. There will be a smart phase to help document this process: .COVIDAMA (go live 3/23/20)

Meals for employees:

Kettering Health Network will provide a menu for employees on the unit. Breakfast, Lunch, and Dinner are provided free of charge.Fill out the menu for the unit, can do individual or group, and fax to nutrition (follow campus protocol). If you need bottled water, please write that on the order form. Dinner orders must be submitted by 6:30pm.

Carts leaving the unit (wheel chairs, ED stretchers, etc.) These items need to be wiped down with purple top Sani Wipes before leaving the unit.