The 2019 novel coronavirus (COVID-19) has changed the way that individuals, communities, and health systems operate in daily life. According to the Centers for Disease Control and Prevention (CDC), there have been more than 4.5 million confirmed cases of COVID-19 and more than 150,000 deaths in the United States as of July 31. In healthcare settings, it is extremely important to decrease the spread of COVID-19 transmission amongst patients, their families, and staff members.
How Hospitals Can Reduce the Spread
Slowing the transmission of COVID-19 in a healthcare setting requires assessing every person who enters the facility for symptoms, enforcing safety protocols such as social distancing and universal masking, making all needed PPE readily available and ensuring it is well stocked for potential surges, managing visitation and vendor accessibility to the hospital, and promoting the use of virtual services.
1. Conducting COVID-19 Symptom Assessments
One of the most important factors in preventing the spread of COVID-19 among healthcare systems is to thoroughly assess each person entering the healthcare facility for COVID-19 symptoms. This is generally done by asking the visitor, patient, or employee a standardized set of symptom-based questions relating to COVID-19. Along with the questionnaire, a temperature check should also be taken. Any patients, visitors, or staff displaying symptoms should be taken to a respiratory triage designated area.
Symptomatic patients with COVID-19 will begin displaying a wide range of symptoms beginning two to 14 days after the transmission of the virus. These symptoms may include:
- Shortness of breath or difficulty breathing
- Sore throat, congestion, and a runny nose
- Fatigue and muscle or body aches
- Fever or chills
- Inability to wake or stay awake
- Nausea, vomiting, and diarrhea
Along with in-person assessments, it is important for employees of the hospital or health system to self-screen at home prior to reporting to work. If an employee is feeling ill, they should immediately notify their direct supervisor and their employee health department for guidance on being tested or quarantined. Employees should only return to work once they have received a negative COVID-19 test result or have been symptom-free for 48 hours, or as per Employee Health Assessment. Keeping sick employees from coming to work can reduce the spread of COVID-19 to both staff and patients.
2. Enforcement of Safety Protocols
A peer-reviewed study in the journal, Nature, found that between January and April, it was found that more than 500 million COVID-19 cases were prevented by enforcing safety protocols like the ones below.
Safety protocols that should be enforced include:
- Hand washing and hand sanitizer use
- Disinfecting high-touch surfaces
- Social distancing
- Universal masking
a. Hand Washing
COVID-19’s ability to live on surfaces for multiple days makes it a threat, even for those practicing social distancing and wearing a mask. According to Harvard Health, “a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.”
To prevent accidental transmission from surfaces to patients, it is recommended for staff to practice thorough handwashing with soap and water throughout the day, for at least 20 seconds at a time. If soap and water are unavailable, a hand sanitizer, with at least 70% alcohol content will suffice. It is also important to clean your hands after handling patients, going to the bathroom, or sneezing and coughing.
b. Disinfecting High-Touch Surfaces
In partnership with hand washing, it is crucial for environmental service team members in the hospital setting to disinfect high-touch and high-traffic areas such as doorknobs, light switches, lobbies, waiting rooms, and patient rooms. This will help reduce the spread of COVID-19 via surface transmissions.
c. Social Distancing
Social distancing can help prevent person-to-person transmission. By remaining six feet apart from others, you are reducing your risk of contracting or transmitting COVID-19. To enforce social distancing in a healthcare setting, it is important to communicate the requirements to patients, visitors, and staff members via signs and floor markers in well-lit areas, including waiting rooms, lobbies, dining areas, and gift shops.
d. Universal Masking
Enforcing a universal masking policy in a healthcare setting is one of the most important safety precautions a healthcare facility can take. Universal masking helps reduce the spread of the virus by reducing the possibility of airborne transmission.
According to the CDC, universal masking prevents those with COVID-19 from spreading the virus to others. The Director of the CDC, Dr. Robert R. Redfield said, “We are not defenseless against COVID-19. Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting. All Americans have a responsibility to protect themselves, their families, and their communities.”
To enforce universal masking:
- Post clear, concise signs at entrances and floors stating that a cloth face covering is required to enter and be in the facility
- Assign personnel to entrances to ensure every person entering the facility is properly wearing a mask (covering their nose and mouth)
- Provide masks at entrances for anyone who does not have a mask readily available to wear.
3. Keeping PPE Supplies Stocked
For healthcare workers, the most vital, and potentially life-saving mechanism for controlling the spread of COVID-19 within the hospital is donning proper PPE. In March, the WHO estimated that worldwide, “89 million medical masks are required for the COVID-19 response each month. For examination gloves, that figure goes up to 76 million, while international demand for goggles stands at 1.6 million per month.”
This high demand for PPE, especially in the beginning of the COVID-19 pandemic, resulted in a shortage for healthcare facilities worldwide. To help prevent a future shortage from occurring, it is important for hospitals to take action early by ordering large amounts of surgical and N95 masks, gowns, gloves, and face shields. Orders can take months to ship during a surge, so ordering early will benefit the hospital and their patients. Along with orders, taking community donations can help prevent a PPE shortage. Hospitals can do this by setting up a donation location and time for the community to assist in supplying the healthcare teams with these vital supplies.
4. Managing Visitation and Vendor Accessibility
Limiting hospital visitation is an important step to slowing the unintentional spread of COVID-19. Although this is a difficult decision for healthcare facilities to make, it is recommended by the CDC that visitation be restricted or limited to decrease the chance of community-based exposure to the virus. Limiting visitation can help heighten the safety of both patients and staff.
For healthcare facilities that do allow visitation during the pandemic, it is recommended that:
- Facilities should offer alternative solutions to visitation, such as video calls with the family
- Patients who are COVID-19 confirmed or who are immunocompromised should be discouraged from having visitors
- Visitation hours be limited
- Visitors should have designated entrances and should be screened for COVID-19 symptoms prior to seeing the patient
- Visitors should be designated by the patient and be assigned a band for identification of visitation status
- Visitors should participate in universal masking or perform respiratory hygiene (covering their mouth and nose for coughing and sneezing)
- Consider no visitor policy, if possible, and arrange for daily phone calls to families for updates from staff, as required.
Along with visitation restrictions, it is recommended to limit hospital vendors from entering the facility, unless strictly needed. The health system’s shipping and receiving team should organize a plan with the vendors for restocking supplies without exposing the hospital staff to potential COVID-19 transmission.
5. Offering Virtual Services
One of the most modern and revolutionary means of slowing virus spread in healthcare facilities is implementing virtual care services. Patients and healthcare staff can benefit from virtual services, such as educational and topic-based seminars and online COVID-19 screening tools.
For patient education and to increase service line business, hosting virtual seminars or physician talks can help provide vital health information to patients without the need for a large, in-person event.
These virtual events and educational opportunities can be conducted via:
- Mass patient emails with pre-recorded video topics
- Social media live videos
- Web conferences
- Webpage questionnaires
Keeping patients aware of general healthcare tips and advice can help reduce hospital admissions, slowing the potential spread of contact-to-contact COVID-19 transmission. Virtual services and educational opportunities can be utilized as a great resource to promote service line volume needs, especially emergency care. Although COVID-19 has taken the forefront on all current patient volumes, it is still important to highlight cardiac, stroke, and emergency care. Data from the National Syndromic Surveillance Program’s health data survey found that in April, at the start of the pandemic surge in the United States, emergency care visits dropped by 42%. This report represents the need for virtual assessments and an emphasis by health systems on the safety measures for patient care.
Online Screening Tools
For many Americans, the fear of contracting the virus has led them to be tested, only to turn up negative. To preserve emergency room space and testing equipment, as well as prevent them from accidentally contracting the virus while visiting an emergency room, online COVID-19 tools are needed. Hospitals should set up an online questionnaire centered on the latest symptom-based methodology from the CDC and WHO. Patients can fill out the questionnaire and the algorithm set up can provide them with a recommendation to seek urgent or primary care, to self-quarantine, or to just monitor their symptoms for worsening severity.
6. Have a Contingency Plan
With the unknown future of COVID-19 spread, it is important for hospitals to develop contingency plans should the increased demand for staffing resources arise due to staff-to-staff or patient-to-staff transmission or increased patient load. Having a contingency plan can help hospitals stay on top of patient volumes and continue to provide quality care amid the crisis. Contingency plans should be on a three to six-month timeline.