[MCOH-EH] [Ext] MCOH-EH Digest, Vol 255, Issue 200
Pounds, Melissa
MPounds at shrinenet.org
Wed Jul 29 08:26:55 PDT 2020
I have moved away from TB skin tests. Predominantly using TSPOT these days.
Melissa A. Uhrig Pounds, MSN, BSN, BSHE, RN, CPST
Director, Educational Services|Coordinator, Occupational Health|Patient Advocacy
Shriners Hospitals for Children® - St. Louis
4400 Clayton Avenue
St. Louis, MO 63110
Phone: 314-432-3600 x1193
Fax: 314-692-6431
E-mail: mpounds at shrinenet.org
Shriners Hospitals for Children: www.shrinershospitalsforchildren.org
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Subject: [Ext] MCOH-EH Digest, Vol 255, Issue 200
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Today's Topics:
1. Re: Virtual PPD readings? (Tara Dockery)
2. Re: Virtual PPD readings? (Auerbach, Karl)
3. Fw: [occ-env-med-l] Projecting RTW dates for employees with
COVID-19 (Abhijay Karandikar)
4. COVID-19 symptom based strategy (Abhijay Karandikar)
5. MedFlight Crew (LeClair-Netzel Megan E)
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Message: 1
Date: Tue, 28 Jul 2020 19:32:38 +0000
From: Tara Dockery <tdockery at oceanbeachhospital.com>
To: MCOH-EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Virtual PPD readings?
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People have tried to get them read by a nurse at home, their mother, etc. for years. I have never allowed this, they need to show up in person for readings and feeling for the induration.
I would not recommend allowing this
Tara Dockery
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of fitzpatv at MSKCC.ORG
Sent: Tuesday, July 28, 2020 6:54 AM
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] Virtual PPD readings?
CAUTION: This email originated from outside your organization. Exercise caution when opening attachments or clicking links, especially from unknown senders.
Does anyone know if literature approves reading negative PPDs by video/remotely? Does it always have to be palpated even if there is absolutely no erythema, or even just a little bruise at the PPD site? Please can you post a link to any article you may know that discusses this.
Much appreciated.
Violet Fitzpatrick RN, COHN
MSKCC
Employee Health & Wellness Service
222 East 70th st (1st floor)
New York NY 10021
Tel: 646 888 4000
Fax: 646 888 4009
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Message: 2
Date: Tue, 28 Jul 2020 23:52:03 +0000
From: "Auerbach, Karl" <KAuerbach at emblemhealth.com>
To: MCOH-EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Virtual PPD readings?
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1. I agree that the person, their mother, etc should not be the one reading. While most are not going to fudge the reading, in occ med and hospitals especially, there are implications of a positive test that the worker may choose to want to avoid- no matter how good the reading
2. I have taught nurses without a relationship to the worker and EMTs to read PPD in person and in some instances will accept that reading provided the reader is a trusted partner and its clear cut.
3. I teach readers to draw a pen point along into the area of induration from 4 directions and then measure. I wonder if the points that are marked have been shown to be reliable I believe they are as reliable if not more reliable than just the finger feeling the raised area and certainly more reliable than visual. And can they then be measured correctly with a virtual view. I think they can but don't know of any literature or studies.
Karl Auerbach MD
Albany NY
My opinions, nothing more....
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Message: 3
Date: Wed, 29 Jul 2020 02:22:33 +0000 (UTC)
From: Abhijay Karandikar <dr_abhik at yahoo.com>
To: edward.galaid at rsfh.com
Cc: mcoh-eh at mylist.net
Subject: [MCOH-EH] Fw: [occ-env-med-l] Projecting RTW dates for
employees with COVID-19
Message-ID: <2139297459.8717978.1595989353603 at mail.yahoo.com>
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Ed,
We have always made RTW decisions related to COVID-19 based on symptom based criteria due to all the issues associated with testing. Employees call in with symptoms and are triaged by the EHS staff and a return to work date is given, based on the most recent guidelines (CDC and our state DOH). EHS staff does not check in regularly. Employees are informed that they should call 24 hours before their RTW date and fill out our RTW screening form essentially attesting that they have no symptoms. If we do not hear back from the employee on or before their RTW date, EHS staff will call to inquire.
I have not heard of a "severity index" but you may find this interesting:
"Covid-19: Study reveals six clusters of symptoms that could be used as a clinical prediction tool
An analysis of data obtained from a symptom tracker app has shown that there are six distinct ?types? of covid-19, each distinguished by a cluster of symptoms. The researchers said that these types could be used to predict the need for respiratory support in severe covid-19.
https://www.bmj.com/content/370/bmj.m2911"
(You would need to copy and paste the above link). I have not seen the actual study myself but it appears that data has been gathered from self-reported information collected from people using smartphone devices
Abhijay
Abhijay P. Karandikar, MD, MPH, FACOEM
Chief, Section of Employee Health
Reading Hospital, PA
On Thursday, July 16, 2020, 05:36:39 PM EDT, Galaid Edward I <edward.galaid at rsfh.com> wrote:
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I?ve cross posted OEM and MCOH.
We are an integrated healthcare system, 4 hospitals, many outpatient sites, 5800+ employees?dealing with staffing shortages because of COVID-19. Trying to provide the managers with projections as to when individuals, post COVID-19, could be fit to RTW. Fortunately, we have top-shelf in-house resources to keep close tabs on these folks. Right now, we have roughly a couple hundred out?as you may have seen on the news, Charleston?s become quite the hot spot, after a relatively quiet Spring.
Questions for the list are 1) if you are case managing, how often are you checking in on your folks and 2) have you heard of a severity index that could help predict how long someone might be out of work?beyond that 10 day minimum.
Thanks for taking the time to respond. Will summarize for the lists.
Ed Galaid
Edward I. Galaid, MD, MPH, FACOEM
ABIM, ABPM (OM)
Medical Director, Occupational Medicine
Roper Saint Francis Healthcare
Charleston, SC 29401
Member, ACOEM Task Group on Law Enforcement Officer Health
Special Expert, NFPA Fire Service Occupational Safety & Health (FIX-AAA) Committee
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Message: 4
Date: Wed, 29 Jul 2020 02:39:40 +0000 (UTC)
From: Abhijay Karandikar <dr_abhik at yahoo.com>
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] COVID-19 symptom based strategy
Message-ID: <1170652099.8733671.1595990380459 at mail.yahoo.com>
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Now that the CDC has issued guidelines strongly in favor of using a symptom based strategy to RTW (https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html) for HCP with COVID-19, I am curious to know the following:
1. Are you using the mild-moderate-severe-critical illness definitions for determining duration of work exclusion (10 vs 20 days) or are you using the minimum (10 days only, with 24 hours of being afebrile, etc.) based on operating in crisis capacity?
2. Clinical judgement is of great importance when using the symptom based strategy. Who does the triaging - staff/OH-EH providers/IP?
3. Are you asking employees to use their ETO/PTO/sick time for time away due to symptoms irrespective of the duration?
4. Are you still offering testing? If so, who pays for the two tests needed 24 hours apart? What is the turnaround time for test results? Does testing result in returning employees much sooner than based on symptoms only, especially since symptoms need to significantly improve as well?
In our institution, we (as guided by IP) have always used the symptom based strategy due to the issues associated with testing. However, there has been an increased demand for testing from employees lately.
Thanks,
Abhijay
Abhijay P. Karandikar, MD, MPH, FACOEM
Chief, Section of Employee Health
Reading Hospital, PA
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Message: 5
Date: Wed, 29 Jul 2020 15:10:09 +0000
From: LeClair-Netzel Megan E <MLeClair-Netzel at uwhealth.org>
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: [MCOH-EH] MedFlight Crew
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Hello,
I am hoping to find resources on how to develop medical standards for nurses, respiratory therapists, and physicians who participate in transports on ground and air.
For example, does your organization follow the Air Force Medical Standards for these roles?
Thank you!
Megan
Megan LeClair-Netzel, DNP, RN, AGCNS-BC
Manager, Employee Health Services
UW Health
(608) 422-8055
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