Very nice process Melanie! 

As you know, Florida cases have increased as have our team member cases.   Our Infection Prevention no longer does any contact tracing of patients.  TMH has dedicated nurses to investigate HCW to HCW and patient exposures.  We rely on the manager to identify healthcare workers who may have been exposed and we send the post exposure instructions(see below)  with the name of the source HCW or patient attached on a HIPAA notification).        We also have a dedicated nurse to answer our COVID-19 hotline during the day and on call nurses to answer afterhours.

TMH also coordinates a COVID-19 testing clinic and we test post exposures and symptomatic team members Mon-Sat from 630am to 2pm with 24 hours turnaround.    In most cases, we are able to get our PCR results with 4-8 hours, so can return team members to work quickly.

We test on average, 150/day but can go up to 200 on a Monday.  We only quarantine close household/community contacts and do not quarantine any work exposures if the team member is asymptomatic.  We test them around day 4-7 after exposure. 

We have a separate COVID cost center that we charge all COVID related labor and expenses to so it won’t affect our productivity metrics.

Dear xxxx manager:

We have received a positive COVID-19 PCR test on a  healthcare worker that was assigned to your unit during the exposure period (starts 48 hours prior to symptom onset).   You may forward this e-mail and attachment, which contains the healthcare worker’s name, exposure period, and notice not to share or further disclose the information,   ONLY  to those individuals who have been identified as having had close prolonged contact (within six feet for over 15 minutes) with this individual during the exposure period on your unit.  This includes notification to ancillary and medical staff who may have been on your unit during the exposure period.

Thank you.  Please call Adrienne Hebert, TMH Clinician at 844-4613 if you have any questions. 

Please forward the information below to the individuals who may have been exposed

COVID-19 POST-EXPOSURE INSTRUCTIONS

TGH Healthcare Worker:   We have received information that a healthcare worker tested positive for COVID-19 in your work area.   Because all healthcare workers are wearing masks within six feet of each other at TGH,  the risk of transmission of COVID-19 in the workplace is considered low.  However, if you may have had close prolonged contact (within six feet for over 15 consecutive minutes),  you should report an exposure as instructed below and come to the TMH screening clinic for testing.   Please review the Post-Exposure Instructions below.   

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An exposure to COVID-19 is defined as:

• Being in close contact for a prolonged period (within six feet for at least 15 minutes or more) with a COVID-19 + person without appropriate PPE (i.e. mask or eye protection)
• This includes:
• HCW was not wearing a face mask or respirator (cloth mask not considered appropriate PPE)

o    HCW was not wearing eye protection if the person diagnosed with COVID-19 was not wearing a cloth face covering or face mask

o    HCW not wearing N95, eye protection, gown, gloves while performing aerosol-generating procedure

• Direct contact with COVID-19 secretions/excretions.  While body fluids other than respiratory secretions has not been clearly indicated in the transmission of COVID-19, unprotected contact with other body fluids such as blood, stool, urine, and vomit might put a HCW at risk and will be treated as an exposure to COVID-19.

Reporting a COVID-19 Exposure:

• Exposed healthcare workers are directed to report an exposure to COVID-19 by completing a COVID-19 Exposure Evaluation on the Team Member Health portal page (My Stuff/Team Member Health/COVID-19/COVID-19 Exposures) or click on the link below. 

• You may also  click on the COVID-19 Exposure Evaluation link below to complete your Exposure Evaluation.  The form will take approximately 5 minutes to complete.  
• Once you click submit, you will receive follow-up instructions via your TGH email on how to make an appointment for your COVID-19 test and IgG antibody test as well as what you should do in the 14 days following your exposure.  If you have any questions about your exposure, please contact a COVID-19 hotline nurse at 813-844-8633.  

• COVID-19 Exposure Evaluation

COVID-19 Testing:

There are two tests we offer TGH team members following a COVID-19 exposure:

COVID-19 PCR testing (Nasopharyngeal Swab) 4-7 days after exposure

The PCR test for COVID-19 detects viral RNA which will be present in the body before you develop antibodies and can tell whether or not you have the COVID-19 virus early on.

How to get your COVID-19 PCR test:

• If you do not have any symptoms, you will not be tested until at least 4 days have passed since your exposure as the virus will not be detected until 4-7 days from exposure and may not be detected after 14 days from exposure.
• If you develop symptoms  within 14 days of this exposure, please report to the TMH screening clinic for testing immediately.  
• You do not need an appointment.  Hours are Monday - Saturday (6:30 am – 2:00pm) in KIDCARE Location.
• The test will require a specimen via a swab through your nose to the back of your pharynx (throat) and can be a little uncomfortable.

COVID-19 IgG antibody testing minimum of 21 days after exposure

The IgG antibody test is usually positive 3 or more weeks after a COVID-19 infection.  This test may indicate if you developed an asymptomatic infection with COVID-19 after an exposure.

    How to get your IgG COVID-19 antibody test:

• You must wait a minimum of 21 days from your exposure to get the IgG antibody test.  Testing is done at the Team Member Health Clinic on the 4th floor of the East Pavilion.
• Please make an appointment on the TMH Appointment Scheduler.  Select Blood Draw C-IgG aka COVID Serology as your appointment type.  To get to the scheduler on the portal, go to "My Stuff" and then click on "Clinic Appointments" under the Team Member Health section.
• If you are unable to make an appointment at a convenient time for you, we will accept walk-ins for post-exposure IgG testing between 6:30am and 4:00pm, Monday - Friday.
• It is important to remember that a positive IgG test does not indicate how much immunity or the duration of immunity you may have to COVID-19.

How COVID-19 is spread

• The CDC suggests that COVID-19 spreads through respiratory droplets when a person with infection coughs, sneezes, or talks.  Droplets can then land in the mouth or nose of a person who is within six feet.  The idea of social distancing is that COVID-19 droplets can generally carry for 5-6 feet.  If you are farther than that from an infected person, your chances of getting the virus are generally lower.
• It may also be possible for a person to contract COVID-19 by touching the surface that has contaminated droplets on it, then touching their mouth, nose, or eyes.  COVID-19 virus may persist on surfaces such as counter tops, doorknobs, cardboard, and fabrics for a few hours or up to several days.  However, the risk of catching COVID-19 from an inanimate surface appears to be low and the virus appears to be killed with standard cleaning methods.
• People can shed the virus before they have symptoms, but this is generally less than individuals with symptoms.

Incubation and Exposure Period:

• An incubation period is the time from the moment you were exposed to COVID-19 until signs and symptoms of the disease appear.  The incubation period for COVID-19 is 14 days, with the average time that a person will develop symptoms after exposure  4-7 days.
•  A  symptomatic person with COVID-19 infection is considered infectious from 48 hours prior to onset of symptoms
• A person who is asymptomatic will be considered infectious from 48 hours prior to positive test results

Work Status

At this time,  most healthcare workers who are asymptomatic will be allowed to return to work as follows:

· Must wear a mask at work at all times;

· Will take twice daily temperatures and inform the COVID-19 hotline nurse if the temperature is 100◦F or greater. 

· Healthcare workers who exhibit any symptoms (i.e. cough, congestion, fever, headache, malaise, body aches, difficulty breathing, fatigue, diarrhea, or nausea) within 14 days post-exposure should not report to work and must call the COVID-19 hotline.  These healthcare workers will be tested immediately for COVID-19 and assessed for work status.

COVID-19 Symptoms

• Common or classic symptoms:   Cough, shortness of breath or chest tightness, fever or chills and new loss of smell and taste
• Other:   Sore throat, muscle aches, fatigue, headache, congestion, runny nose, diarrhea, nausea

 Please let us know if there is anything else we can do to assist you and your team.  

Please call the COVID-19 Hotline at 813-844-8633 to speak to a Team Member Health nurse if they have any questions.

JoAnn Shea, APRN, MS, COHN-S

Director, Team Member Health and Wellness

Tampa General Hospital

Office: 813-844-7692

Cell:      813-789-3441

jshea@tgh.org

From: MCOH-EH <mcoh-eh-bounces@mylist.net> On Behalf OfSwift, Melanie D., M.D., M.P.H. via MCOH-EH
Sent: Monday, July 6, 2020 2:49 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie@mayo.edu>
Subject: Re: [MCOH-EH] COVID-19 employee contact tracing in healthcare facilities

Our model is published here: https://doi.org/10.1016/j.mayocp.2020.05.008

Melanie

Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center

Associate Medical Director, Occupational Health Service

Senior Associate Consultant

Assistant Professor of Medicine

Division of Preventive, Occupational, and Aerospace Medicine

Phone 507.284.2560

_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org

From: MCOH-EH [mailto:mcoh-eh-bounces+swift.melanie=mayo.edu@mylist.net]On Behalf Of Hartley, Patrick
Sent: Monday, July 6, 2020 1:14 PM
To: MCOH-EH
Subject: [MCOH-EH] COVID-19 employee contact tracing in healthcare facilities

Colleagues:

In your respective institutions, which department is responsible for contact tracing of significant exposures to COVID-19 among healthcare personnel?

Is it the responsibility of employee health, infection control/hospital epidemiology or some hybrid of these services?

Thanks

Pat

Patrick G. Hartley,  M.B., B.Ch., B.A.O., M.P.H.

Professor (Clinical) of Internal Medicine

Division of Pulmonary Diseases, Critical Care and Occupational Medicine

Medical Director: University Employee Health Clinic & UIHC Occupational Medicine Clinic

University of Iowa Carver College of Medicine

Iowa City, IA 52242-1009

patrick-hartley@uiowa.edu

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