Testing and testing criteria

Testing criteria

The indications for testing issued by the State Hygienic Lab and the Iowa Department of Public Health have been changing often. The current test criteria is listed below, but are subject to further changes over time:

  • Hospitalized patients with fever and respiratory failure and no alternate diagnosis
  • Older adults (>60 years of age) with fever and respiratory symptoms (cough, difficulty breathing) and chronic medical conditions (e.g., diabetes, heart disease, immunosuppressive medications, chronic lung disease, or chronic kidney disease)
  • Persons with fever or respiratory illness who live in congregate setting (i.e., long term care facilities, dormitories, residential facilities, correctional facilities, treatment facilities)
  • Essential services personnel with fever or respiratory illness (i.e., healthcare providers, fire and EMS, law enforcement, residential facility staff)
Ordering COVID-19 testing

The Epic order name is (“Novel Coronavirus COVID-19”). We hope eventually to have more testing capacity, but there are nationwide shortages of several items needed for testing. Because of this, the Epic order will still require you to select a test indication from the categories outlined below:

  • Hospitalized patients with fever and respiratory failure and no alternate diagnosis
  • Older adults (>60 years of age) with fever and respiratory symptoms and chronic medical conditions (e.g., diabetes, heart disease, immunosuppressive medications, chronic lung disease, or chronic kidney disease)
  • Persons with fever or respiratory illness who live in congregate setting (i.e., long-term care facilities, dormitories, residential facilities, correctional facilities, treatment facilities)
  • Essential services personnel with fever or respiratory illness (i.e., health care providers, fire and EMS, law enforcement, residential facility staff)

If your patient does not fall into one of the above categories but you have clinical suspicion for COVID-19, you will still be allowed to place the order. However, in the event of a testing shortage the test may be canceled or may have a longer turnaround time. We must prioritize testing to those for whom test results will have the greatest impact. Test orders will be reviewed for appropriateness.

Importantly, you no longer need to contact epidemiology to get approval for testing.

In addition, due to ongoing shortages of nasopharyngeal (NP) and oropharyngeal (OP) swabs, the sample requirements for the test (NP swab, OP swab, sputum) may change over time as availability changes. We will do our best to update the Epic order to list the preferred specimen type first. Please note that NP swab, OP swab, and sputum are considered equivalent for diagnosis of COVID-19.

For questions, please contact the Clinical Microbiology Laboratory (6-2591) or Bradley Ford, MD, PhD (bradley-ford@uiowa.edu), or Daniel Diekema, MD (daniel-diekema@uiowa.edu).

Personal protective equipment (PPE)

PPE for treating a suspected or confirmed COVID-19 patient

If a health care worker believes that a patient may have COVID-19, they should place a surgical mask on the patient and move the patient to a private room. Surgical masks placed on sick individuals help keep others healthy. The health care worker should then follow the precautions below:

Follow standard precautions, contact precautions, and droplet precautions by wearing the following:

  • Gown
  • Gloves
  • Surgical mask
  • Goggles or face shield

The only time a mask needs to be worn with a face shield is if you are caring for a confirmed or suspected COVID-19 patient. If an aerosol generating procedure is performed on a confirmed or suspected COVID-19 patient, an N95 mask should be worn with the face shield.

The health care worker should then also limit access to the patient room.

Faculty and staff who wear N95 masks as part of their jobs undergo a fit test to make sure there are no gaps around their mouths. Faculty and staff are discouraged from stockpiling personal protective equipment (PPE) and they should not take PPE home from UI Health Care locations.

More guidance on the PPE necessary for caring for suspected or confirmed COVID-19 patients can be found here on The Point.

Face shields

When you should use a face shield

The face shield should be used for all patient encounters when you are within 6 feet of the patient. In other words, face shields are now part of preferred precautions.The purpose is to protect your eyes, nose, and mouth from infectious droplets. The face shield is to be worn in the place of a face mask. It provides better coverage of your face and has the added benefit of keeping you from touching your face.

The only time a mask needs to be worn with a face shield is if you are caring for a confirmed or suspected COVID-19 patient. If an aerosol generating procedure is performed on a confirmed or suspected COVID-19 patient, an N95 mask should be worn with the face shield.

When you can expect to receive a face shield

Face shields are to be used by everyone who sees patients on the unit or in the clinic. Unit-based staff (e.g., nurses, nursing assistants) will have a face shield assigned for their shift. Others will check one out on arrival to the unit or clinic and return as they leave the unit (e.g., rounding physicians, consultants, PT/OT).

Cleaning and removing face shields

Face shields should be cleaned after each use. View instructions for proper cleaning of face shields on The Point.

Importantly, we have already had multiple reports of face shields breaking. This has occurred when trying to remove it by pushing upward on the bottom of the clear shield.

To remove the face shield without damaging it, loosen the knob that sits over the back of your head, and lift the face shield off with a straight upward motion of the headpiece (not the clear shield).

Please contact the Infection Prevention Program with any questions at 319-356-1606.

Reuse of PPE

Patient care staff: New guidelines for PPE reuse

Updated March 23, 2020: Guidance for Personal Protective Equipment (PPE) Conservation. Please note: This guidance replaces prior guidance. 

We are continuing to seek safe and reasonable ways in which we can conserve personal protective equipment to protect our staff now and in the future. Click here to view more details about PPE reuse and how to clean materials on The Point.

View on The Point (HealthCareID login required):

Gowns

Conserving our PPE: New guidance on gowns

Effective immediately, gowns will no longer be worn by faculty and staff treating patients in contact precautions for conditions other than confirmed or suspected COVID-19 and those under 2 years old with a viral respiratory illness. Gloves will continue to be used.

This measure is being taken to preserve the supply of gowns for patients with COVID-19. The Program of Hospital Epidemiology strongly recommends bare below the elbows in order to avoid sleeve contamination, and a continued focus on hand hygiene before and after all patient contact. As always, gowns should be worn if a splash or spray of blood or body fluids is anticipated.

Please contact Epidemiology (319-356-1606) for any questions regarding this temporary change in practice.

PPE training

Training for all faculty and staff with patient contact

As part of University of Iowa Health Care’s ongoing efforts to protect the health of our community, we want you to be fully prepared should you care for patients with symptoms of COVID-19. We recognize that many of you have already had PPE training. This provides an additional opportunity to reinforce your knowledge with current video examples.

To help contain the 2019 Novel Coronavirus (COVID-19), as well as ongoing flu instances, all employees with patient contact are required to complete these refresher trainings for use of personal protective equipment (PPE). The training courses are available online as compliance issues through Employee Self-Service and need to be completed by March 31.

For areas with a high potential to take suspected or confirmed COVID-19 patients, staff should complete the course as soon as possible. It will take approximately 10-20 minutes to complete.

For those UI employees who wish to take the training—but are not required—please note that it’s available through My Training in Employee Self-Service.

PPE conservation

UI Health Care is implementing centralized strategies to optimize the supply of our personal protective equipment (PPE) and reviewing potential clinical contingency plans.

Securing PPE/ensuring the highest level conservation

Effective immediately, we are following maximum conservation protocols for all critical personal protective equipment (PPE) and testing supplies. Although we presently have enough supplies, our supply chain remains vulnerable and availability changes daily. With everyone’s help, we can do this effectively while maintaining safety for our faculty and staff.

Our Supply Chain/Materials Management department is now centralizing the management of these supplies to ensure conservation and proper use. We ask that everyone support us in these efforts and escalate any issues to the Emergency Management structure.

Although we presently have enough supplies, our supply chain remains vulnerable and availability changes daily. To continue to keep people safe, we are implementing strategies to optimize the supply of our personal protective equipment (PPE) and are focused on clinical contingency planning.

Health care team members caring for patients in isolation precautions should only include the minimum number of individuals necessary for ensuring proper patient care. Additionally, rounding teams should only have the attending and one house officer enter the rooms of patients in isolation precautions.

Clinical resources

Symptoms of COVID-19

For confirmed COVID-19 cases, reported illnesses have ranged from mild symptoms to severe illness.

According to the Centers for Disease Control and Prevention (CDC), frequently reported signs and symptoms include:

  • Fever (83–98%), cough (46–82%), myalgia or fatigue (11–44%), and shortness of breath (31%) at illness onset. Sore throat has also been reported in some patients early in the clinical course.
  • Less commonly reported symptoms include sputum production, headache, hemoptysis, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms.
  • The fever course among patients with COVID-19 is not fully understood; it may be prolonged and intermittent. Asymptomatic infection has been described in one child with confirmed COVID-19 and chest computed tomography (CT) abnormalities.
  • Risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Most reported cases have occurred in adults (median age 59 years).

The CDC believes at this time that symptoms of COVID-19 may appear in as few as 2 days or as long as 14 days after exposure.

COVID-19 treatment guide

We have updated guidance on the therapeutic options available for the treatment of patients with COVID-19.

You can review these guidelines on The Point here.

Employee health

If you are concerned about symptoms:

If staff are concerned about having symptoms of COVID-19, call ahead to the University Employee Health Clinic at 319-356-3631. Please do not arrive in person unless you’ve been told to do so for follow-up.

If you have traveled outside the state of Iowa or outside the country, or have been in contact with someone who has tested positive for COVID-19:
  • You can continue working if you are asymptomatic. Please self-monitor by taking your temperature twice daily (before and after shifts) and assess for a new cough or new fever. Fever is considered 100.4 or above.
  • If you have symptoms of fever or new cough, please do not come to work. Notify your supervisor and call University Employee Health Clinic (UEHC) at 319-356-3631 to discuss your symptoms and determine if you need to be tested for COVID-19.
If you are tested for COVID-19:
  • Please notify your supervisor or HR representative.
  • Stay home and isolate from others in your household until you have your test results. Then, use the following guidance depending on the result of your test:
If you tested positive for COVID-19:
  • Please notify your supervisor or HR representative.
  • Call the University Employee Health Clinic (UEHC) at 319-356-3631.
  • Stay home and isolate from others in your household, until:
  • At least seven days have passed since your symptoms first appeared AND you have been fever-free for 72 hours without the use of fever-reducing medicine AND other symptoms (cough and shortness of breath), if any, have improved.

Please contact UEHC (319-356-3631) before returning to work, so that they can review your symptoms and determine that that it is safe to do so.

If you tested negative for COVID-19:
  • Please notify your supervisor or HR representative.
  • You may return to work once you have been fever-free for 24 hours without the use of fever-reducing medicine AND have no other new respiratory symptoms (cough and shortness of breath).

Travel

Current UI Health Care travel restrictions

Work-related domestic travel suspended for UI Health Care employees

To ensure adequate staffing levels, all UI Health Care work-related domestic and international travel has been suspended until further notice.

  • Work-related travel within Iowa and with groups of less than 20 people is permitted.
  • All other work-related exceptions to travel must be approved by Brooks Jackson, MD, MBA, UI Vice President for Medical Affairs. Requests for exceptions should be submitted to ui-coronavirusquestions@uiowa.edu.
  • All personal travel should be carefully considered.

Any planned recruits coming to campus should follow their institution’s guidelines. It is recommended that you use video technology or postpone recruitment visits, as needed.

Any other questions should be submitted by emailing ui-coronavirusquestions@uiowa.edu.

The Board of Regents, State of Iowa, has instituted a ban on university-sponsored international travel for the next 30 days due to the 2019 Novel Coronavirus (COVID-19) outbreak. This ban applies to faculty, staff, and students and is effective immediately. International travel will continue to be evaluated and any updates will be immediately communicated to those impacted given the fluid nature of the situation.

Additionally, the Board of Regents has announced that faculty, staff, and students who are already out of the country will be recalled from any country when the CDC designates or raises its warning to a Level 3-Avoid Nonessential Travel. The university is currently in compliance with this guideline and will implement changes as needed based upon new guidance as the situation evolves. More information about this announcement can be found here.

“University-sponsored” does not mean personal travel but includes any of the following:

  • University staff, faculty, or students who are traveling due to their position with the university.
  • Funding is being provided by the university.
  • Funding is provided by a grant or contract that is managed by the university.
  • Funding is provided by a third party, but the purpose of the travel is due to the staff or faculty’s position within the university.

As Brooks Jackson, MD, MBA, UI vice president for medical affairs and the Tyrone D. Artz Dean of the Carver College of Medicine, shared in the recent faculty and staff forum on COVID-19, “We have to keep in mind that as health care providers, we are the front line defense for our patients and people coming in [to our facilities].”

Returning to work after travel

At this time, we are asking UI Health Care employees and volunteers who landed in the United States on or after the following dates after travel to China, Italy, Iran, Japan, South Korea, or Hong Kong to:

  • Please contact University Employee Health Clinic at 319-356-3631 prior to returning to work. If you are currently at work after recent return from any of these countries outlined above, please contact University Employee Health Clinic immediately.
  • After business hours and on weekends, please contact the Program of Hospital Epidemiology by paging 3158.

China

On or after Sunday, Feb. 2

Japan and Hong Kong

On or after Thursday, Feb. 19

South Korea

On or after Tuesday, Feb. 24

Italy and Iran

On or after Saturday, Feb. 28

For Human Resources-related questions to this, please call 319-356-2122.

Travel precautions

Travel is not recommended. If you travel, the CDC recommends the following routine precautions:

  • Avoid contact with sick people.
  • Avoid touching your eyes, nose, or mouth with unwashed hands.
  • Clean your hands often by washing them with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains 60%–95% alcohol. Soap and water should be used if hands are visibly dirty.
    • It is especially important to clean hands after going to the bathroom; before eating; and after coughing, sneezing, or blowing your nose.
Do you have questions about COVID-19?

For general questions regarding COVID-19, please call our helpline at 319-384-8819.

The safety of our patients, faculty, staff, and volunteers is a top priority for University of Iowa Health Care. This page will continue to have up-to-date information and resources for health care employees regarding our preparation and response to COVID-19.

More information for patients is available at uihc.org/2019-novel-coronavirus-covid-19.