March 31, 2020 — 2:00 p.m.
DHEC has confirmed multiple cases of COVID-19 in South Carolina. SCHA continues to host calls with DHEC to address the concerns of the state’s hospitals and health systems. The next COVID-19 update call with DHEC is scheduled for Thursday, April 2 at 1:00 p.m. If you are an SCHA member and would like to be added to the call or email update, please send an email to firstname.lastname@example.org.
Lab Developed Tests
Hospitals wanting to conduct their own Lab Developed Test for COVID-19 may do so after submitting the appropriate paperwork, including five negatives and five positives, to the FDA. DHEC can assist with sample validation, and approval from the FDA is not required to begin testing. If you have any questions, contact Dr. Atwell Coleman, Director of DHEC’s Public Health Laboratory at email@example.com.
Guidance on Elective Procedures
In addition to Governor McMaster’s recent recommendation that healthcare providers halt all “elective, non-threatening” surgeries and procedures, CMS has also recommended that providers limit non-essential adult elective surgery and medical and surgical procedures.
Hospitals and health systems across South Carolina are adjusting their visitor’s policies to adapt to COVID-19. Many facilities are implementing a “no visitors” policy that would limit visitors to end of life situations.
COVID-19 Emergency Declaration
The federal government is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers combat and contain the spread of COVID-19. CMS is empowered to take proactive steps through 1135 waivers and rapidly expand the Administration’s aggressive efforts against COVID-19. As a result, these blanket waivers were made available to healthcare providers.
CMS has also released a series of nationwide blanket Section 1135 waivers that included the remaining items requested by SCHA. These new waivers give hospitals greater flexibility to conduct medical screenings in alternate locations, delay various documentation or reporting requirements, and transfer patients across settings as needed to create capacity in acute care hospitals or to prepare for cohorting of COVID patients. The waivers are retroactively effective as of March 1, 2020; the use of this waiver authority does not require any notice to CMS.
The CMS guidance also includes a fact sheet for hospitals that explains what other flexibility is now available. CMS has also revised and re-released its memorandum that specifically addresses how hospitals are permitted to screen patients at various on-campus and off-campus locations.
CMS simultaneously released a sweeping new “interim final” regulation that will apply for the remainder of the public health emergency and broadly casts aside the traditional limitations on Medicare’s coverage of telehealth services.
Annual Fit Testing Requirements
OSHA has issued guidance that temporarily suspends the annual fit-testing requirement for respirators and recommends using “qualitative” fit tests for healthcare workers in response to COVID-19. OSHA will exercise discretion in enforcing the annual fit testing requirements for employers who:
- Make a good-faith effort to comply with 29 CFR § 1910.134;
- Use only NIOSH-certified respirators;
- Implement CDC and OSHA strategies for optimizing the supply of N95 filtering facepiece respirators and prioritizing their use, as discussed above;
- Perform initial fit tests for each HCP with the same model, style, and size respirator that the worker will be required to wear for protection against COVID-19 (initial fit testing is essential to determine if the respirator properly fits the worker and is capable of providing the expected level of protection);
- Inform workers that the employer is temporarily suspending the annual fit testing of N95 filtering facepiece respirators to preserve and prioritize the supply of respirators for use in situations where they are required to be worn;
- Explain to workers the importance of performing a user seal check (i.e., a fit check) at each donning to make sure they are getting an adequate seal from their respirator, in accordance with the procedures outlined in 29 CFR § 1910.134, Appendix B-1, User Seal Check Procedures.4 See also, OSHA tutorial videos (English, Spanish).5
- Conduct a fit test if they observe visual changes in the employee’s physical condition that could affect respirator fit (e.g., facial scarring, dental changes, cosmetic surgery, or obvious changes in body weight) and explain to workers that, if their face shape has changed since their last fit test, they may no longer be getting a good facial seal with the respirator and, thus, are not being adequately protected; and,
- Remind workers that they should inform their supervisor or their respirator program administrator if the integrity and/or fit of their N95 filtering facepiece respirator is compromised.
DHEC has announced that the Department’s prior approval for COVID-19 testing is no longer required. Reference the full announcement in the March 13 DHEC Health Update. If you don’t have viral transport media, DHEC has approved using a NP swab placed in 3cc of saline as a substitute. All other collection and transport processes would remain the same.
DHEC continues to offer testing services and reference labs including LabCorp and Quest Diagnostics can test for COVID-19 also. DHEC is unable to provide clinical services, so patients should not call DHEC directly for testing. Members of the public who would like information related to coronavirus should contact the DHEC Care Line at 1-855-472-3432. A triage nurse is on standby to help provide guidance. Hospitals should contact 1-888-847-0902 to report any suspect COVID-19 patients if DHEC staff is unavailable.
Drive-Through Collection Sites
Hospitals and health systems across South Carolina have answered the call to expand testing capabilities with drive-through collection sites. Here are the current appointment only drive-thru sites that SCHA is aware of:
- Beaufort Memorial Hospital 8am-8pm Monday-Friday; 8am-5pm Saturday; and 1-5pm Sunday. Beaufort Memorial Medical and Administrative Center at 990 Ribaut Road.
- MUSC Health University Medical Center Citadel Mall campus in West Ashley.
- MUSC Health Florence Medical Center Doctors Care Urgent Care on 2200 South Irby Street in Florence
- MUSC Health Lancaster Medical Center 11am-1pm Monday-Friday. 1010 Woodland Drive.
- Prisma Health Greenville Memorial Hospital 9am-6pm, Monday-Friday. Lower level of the South Parking Deck.
- Prisma Health Richland Hospital 9am-12pm and 1-5pm, Monday-Friday. Outside North Portal, near the ED.
- Prisma Health Tuomey Hospital 9am-5pm, Monday-Friday. At the Calhoun St./Day Surgery entrance.
- Roper St Francis Healthcare 8:30am-5pm Monday-Friday. Roper St. Francis Transitions Clinic in North Charleston.
- Self Regional Healthcare 9am-5pm, Monday-Friday.
DHEC Outpatient Instructions for Potential COVID-19 Patients
DHEC has released updated guidance for South Carolina hospitals and health systems to provide to potential COVID-19 patients. These new outpatient instructions help inform patients under investigation on how they will be followed up with and how to self-isolate. DHEC has also released guidance for persons who have had close contact with a COVID-19 case. Members of the public who reach out to hospitals seeking general information about COVID-19 should be directed to the DHEC Care Line at 1-855-472-3432. A triage nurse should be available.
Personal Protective Equipment (PPE)
SCHA recognizes that hospitals are concerned about the supply of masks, gloves, gowns and other PPE. While most facilities have adequate supplies for a normal volume of patients, all hospitals and health systems should be considering certain strategies to preserve access to PPE:
- Consider implementing conservation procedures. For example, keep all students, observers and non-critical vendors out of isolation areas to conserve supply.
- Consider practices to extend the use and limited reuse of N95 respirator masks. Follow the CDC’s recommended guidance for getting the most out of your N95 respirator mask supply.
- Take a full inventory of all PPE. Even some out-of-date supplies are permissible for use in a state of emergency.
The Family Medicine Residency Program at AnMed Health is sharing an innovative practice for conserving N95 mask supply. Their infection control department has reviewed and permitted an easy-to-make N95 cover that allows the mask to be used multiple times by discarding the cover with each use. Also please be sure to review the most recent guidance from the CDC with more strategies to optimize your PPE supply.
SCHA continues to compile potential resources of items like masks, hand sanitizer, face-shields, gowns, laboratory testing, testing supplies, etc. Our spreadsheet of suppliers will be updated periodically. Remember, these companies have not been fully vetted and are not endorsed partners of SCHA or Solvent Networks. We encourage you to use your own discretion in utilizing these vendors and consult the SC State Fiscal Accountability Authority to see if the state has any information on a given company. If you receive any unsolicited contacts from a vendor that you have no experience with offering needed supplies, you can send that vendor or the vendor’s information to firstname.lastname@example.org.
Several South Carolina health systems are offering telehealth access to the public. These options are available to anyone experiencing COVID-19 symptoms in South Carolina:
Guidance for Alternative Care Sites
CMS has provided updated guidance on EMTALA requirements related to COVID-19 that provide for the establishment of alternate care sites on hospital campuses, or through off-campus, hospital-controlled sites. All hospitals should contact DHEC to confirm the placement of their alternate care site. CMS has announced that they will suspend all field work other than emergency only at this time and continue to host weekly calls with hospitals every Monday at 12 p.m.
Joint Commission to Suspend Surveying
In response to the COVID-19 outbreak, the Joint Commission (TJC) said that beginning March 16, it will suspend all TJC surveying. The TJC has notified the Centers for Medicare & Medicaid Services of its decision and CMS has agreed.
TJC said that it anticipates that survey delays, as well as other activities, will be on hold at least until the end of April; however, it is conducting planning scenarios that assume longer periods of suspension. TJC also said it is working with field staff and customers on plans to redirect TJC resources to best assist healthcare providers during this difficult time.
The CDC has determined that medical waste generated in the treatment of COVID-19 patients and patients under investigation be managed in accordance with routine procedures. There are no additional packaging or transportation requirements from the Department of Transportation for regulated medical waste or sharps. Stericycle has updated coronavirus-related packaging guidelines for regulated medical waste and sharps:
- Reusable sharps containers generated in the isolation rooms for confirmed coronavirus cases must be placed in a red bag and disposed of as regulated medical waste.
- Stericycle strongly recommends using single-use (disposable) sharps containers in these areas where confirmed cases will be managed.
The CDC also has a Q&A section dedicated to coronavirus waste management in a healthcare setting.
Aya Healthcare, in partnership with Qualivis, has enacted an emergency preparedness and rapid response staffing unit to assist facilities in planning and caring for increased patient census and/or low core staff availability due to COVID-19. While this is a significant resource for hospitals for covering shifts, know that the rapid response service is available at a premium rate. Because the assignments require quick start dates, are short in duration, and include working in a potentially high-risk environment, hourly rates are higher than typical temporary staffing assignments.
If you need additional staffing resources and are a current Qualivis customer, reach out to your account specialist. If you are not currently a Qualivis client, contact Sherry Kolb at 803.609.6862.
As part of DHEC’s outreach efforts, they are providing tools to help businesses and other organizations with messaging for the public. DHEC will continue to partner with the CDC to provide the latest information at scdhec.gov/2019CoronaVirus. These materials can be printed for physical use in your facilities or used on social media to educate your community on COVID-19:
- What you need to know about COVID-19
- COVID-19 quick facts
- Preparing for the spread of COVID-19
- What is the difference between isolation and quarantine?
- Stop the spread of germs
Hospitals are also educating the public on how to reduce the spread of COVID-19. Leaders at Tidelands Health have developed a valuable communications campaign to educate their community on social distancing. Tidelands Health is aligning its messaging with federal recommendations encouraging community members to maintain a distance of at least six feet from others and minimize personal contact by limiting travel, avoiding gatherings of people and taking other steps. They have also created a video to serve as a public service announcement to their community.
As your facility responds to COVID-19, use your website and social media to educate the public. Tell your story and update your community on any changes in operations at your facility.
DHEC is asking all hospitals to report bed status every six hours (6 a.m., 12 p.m., 6 p.m., 12 a.m.) into the Bed Availability and Reporting Tool until further notice.
Centers for Disease Control and Prevention
- CDC Coronavirus 2019 Situation Summary
- CDC Coronavirus 2019 Information for Healthcare Professionals
- CDC Coronavirus 2019 Travel Information
SC Department of Health and Environmental Control
If you would like to be added to DHEC’s email distribution list for updates on COVID-19, please send your contact information to email@example.com. If you have any questions or concerns related to your facility’s ability to respond to COVID-19, please send an email to the SCHA Disaster Team at firstname.lastname@example.org.