Contact the Program of Hospital Epidemiology at 319-356-1606 or 24-hour pager 3158.
Latest guidance and policies from our Program of Hospital Epidemiology.
Chief Medical Officer Theresa Brennan, MD, and the Operations branch of the UI Health Care Hospital Incident Command System (HICS) have reviewed each line of Iowa Governor Kim Reynolds’ order on personal protective equipment (PPE) and has determined that UI Health Care is in compliance with the order.
This site is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. All information is meant for use by health care workers and not the general public. If you think you may have a medical emergency, call 911 or go to the nearest emergency room immediately. No physician-patient relationship is created by this web site or its use. Neither the University of Iowa nor its employees, nor any contributor to this web site, makes any representations or warranties, express or implied, with respect to the information provided herein or to its use.
Guidance on face masks
Effective Wednesday, March 8:
Face masks will be optional for all in our facilities, except for those who have symptoms of a respiratory virus or for those employees who are unvaccinated, for which masks remain required.
Masks are welcome for anyone who chooses to wear one. This change to our guidance was made in partnership with our Program of Hospital Epidemiology.
Where masks are still required
- Face masks remain required for anyone who has symptoms of a respiratory virus
- Face masks also required for pre-pandemic standards of masking in places like the OR, procedural areas, isolation, etc. for safety and infection prevention protocols.
Effective Wednesday, March 8:
Face masks will be optional for all in our facilities, except for those who have symptoms of a respiratory virus, for which masks remain required.
Masks are welcome for anyone who chooses to wear one. This change to our guidance was made in partnership with our Program of Hospital Epidemiology.
Where masks are still required
- Face masks remain required for anyone who has symptoms of a respiratory virus
- Face masks also required for pre-pandemic standards of masking in places like the OR, procedural areas, isolation, etc. for safety and infection prevention protocols.
Frequently asked questions about face masks
General safety and infection prevention principles
The safety of our staff and patients always comes first. Please take care of yourself and your work spaces as we strive to do our best for each other, our patients, and our community.
In clinical settings:
- View the latest on the required PPE in clinical and non-clinical settings here.
- Keep arms bare below the elbows in order to avoid sleeve contamination. This means that there should be nothing on your forearms, including wrist jewelry and watches. If you wear a long-sleeved shirt, roll up the sleeves.
- Neckties, scarves, and long necklaces should not be worn.
- Tie or clip up long hair.
- Wipe down your stethoscope after each use.
Work rooms and commonly shared work spaces:
- Wipe down surfaces with disinfectant wipes often.
- It’s time to declutter. If surfaces are cluttered they are unable to be cleaned.
- Wipe down shared computer keyboards, phones, door knobs, and other items you frequently touch before using.
Other best practices:
- Wash your hands often and avoid touching your face.
For staff who wear green scrubs:
- Green scrubs are not to be worn outside of the hospital. If you currently have green scrubs at home, please bring them back to work as soon as possible so they can be laundered and reused appropriately.
A team has been regularly monitoring our supply of disinfectants over the past year. Recently, our supply of hospital-approved disinfectant wipes has grown enough that we can return to the use of approved disinfectant wipes, e.g. PDI AF3 (Grey top) wipes. Please place your order through Hospital Stores (6-1784).
Use bleach wipes to disinfect surfaces for suspected and confirmed COVID-19 patients. Follow below guidance for all other patients.
Note: PDI Prime (Pink tops) wipes are available for disinfecting equipment that require alcohol. It may be used as a red top replacement. Staff should read the equipment Instructions For Use (IFU) or reach out to their equipment sales representative with additional questions.
Oxivir® Ready to Use
For use as a one-step cleaner/disinfectant for environmental surfaces
(Reserved for Operating Rooms disinfection)
INSTRUCTIONS FOR USE:
- Carefully pour Oxivir® solution onto a new disposable cloth.
- Wet cloth with disinfectant; cloth should be damp, not dripping.
- Wipe all hard, non-porous surfaces with damp cloth.
- All surfaces must be visibly wet and allowed to air dry.
Note: Do not directly apply on electronics.
*DO NOT DISCARD EMPTY REFILL BOTTLES (Refill bottles will be cleaned and reused)
Oxivir® may be used to fill and refill clean, properly labeled containers.
*DO NOT POUR SOLUTION IN TUB OR BUCKET FOR MULTIPLE USES
Rationale: Improperly handled disinfectants may be contaminated with organisms that could lead to hospital-acquired infections.
INSTRUCTIONS FOR ORDERING:
- Call Stores (6-1784) to request new supply.
- Oxivir® Ready to Use solution – Reusable (use PS# 139831)
- Wipe Disposable for Oxivir® Ready to Use solution (use PS#156334)
- Stores will deliver a new supply of Oxivir® and pick-up empty bottle(s).
Reference:
William A. Rutala, P. M. (n.d.). Frequently Asked Questions. Retrieved from How should readers interpret the recommendation about contact time for disinfectants: http://vtwqt464m234djrhbie88e10-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/FAQ_Contact-time-for-disinfectants-used-on-noncritical-items.pdf
Keah KC. Et al. Bacterial Contamination of Hospital Disinfectants. http://www.e-mjm.org/1995/v50n4/Hospital_Disinfectants.pdf
Developed: Program of Hospital Epidemiology and Environmental Services 04/29/2020
For staff who wear green scrubs:
Green scrubs are not to be worn outside of the hospital. If you currently have green scrubs at home, please bring them back to work as soon as possible so they can be laundered and reused appropriately.
N95 respirators
Our supply of N95 masks is stable enough for all frontline, direct care staff to use N95 masks when caring for COVID-19 patients and persons under investigation (PUI) for COVID-19.
This guidance is applicable in all areas, except for perioperative and procedural settings (including the delivery rooms) where the patient has had a negative COVID-19 test in the last 48 hours. Personnel caring for patients who do not have COVID-19 in the NICU are not required to wear N95s during AGPs. In these settings existing PPE guidance should continue to be followed.
If you have not yet been fit tested to an N95
- First, complete the required OSHA survey in ReadySet
- Schedule a fit testing with the University Employee Health Clinic (UEHC). You can do this by calling UEHC at 319-356-3631 to schedule your 15-to-20-minute appointment. UEHC is located at 1097-1 Boyd Tower, at UI Hospitals & Clinics (Elevator A, Level 1). Hours are from 7:30 a.m. to 4:30 p.m., Monday through Friday.
If you have already been fit tested to an N95
If you have already been fit tested to an N95 respirator, please confirm the make and model of your respirator by following these instructions.
If you are already fit tested to any other type of N95, no further action is needed.
View frequently asked questions about N95 respirators.
General personal protective equipment (PPE) guidance
Interim instructions for caring for a patient with COVID-19 (person under investigation* or confirmed)
Aug. 19, 2021
Please send requests for additional guidance to: InfectionPrevention@healthcare.uiowa.edu
Urgent requests: page 3158.
| Situation | Guidance |
| Isolation Precautions
PPE* in all clinical settings (Inpatient and Outpatient) |
Modified Airborne + Contact Precautions + Eye Protection
Respirator (N95 or CAPR) + gown and gloves + face shield or goggles NOTE: Staff—regardless of vaccination status—are required to wear an N95 respirator while caring for a patient with COVID-19 or for a person under investigation for COVID-19 (PUI). This guidance applies to both the inpatient and outpatient setting. |
| Patient transport (procedures or transferring units) | Limit transport and movement of the patient outside of the patient room to medically essential purposes.
If procedures or tests are required and not able to be performed in the patient room OR if patient is being transferred to another unit, follow these steps:
Receiving personnel should wear PPE for airborne, contact and eye protection (gloves, gown, respirator and eye protection) After transport, equipment must be cleaned with approved disinfectant. To transport patients who require care during transport (e.g. a critically ill patient) follow the guidance above with the addition of:
|
| Food and Nutrition | Nursing will take food trays into patient room and also remove them from patient room. No special handling of food tray necessary. |
| Environmental infection control | Use bleach wipes to disinfect surfaces, regardless of patient location (inpatient, procedural area, outpatient).
Inpatients Daily cleaning:
Terminal cleaning (after discharge):
Procedural Areas (not Operating Room)
Outpatients
|
*Definitions
- COVID-19 person under investigation: a person that is going to be or has been tested for COVID-19 and is awaiting results.
- Modified Airborne precautions PPE: respirator (N95 respirator or CAPR)
- Negative pressure room not required but recommended if available
- Contact precautions PPE: gown + gloves
- Eye protection: face shield or goggles
- Aerosol generating procedures:
- nebulized medication administration
- manual ventilation before intubation
- endotracheal intubation
- extubation
- BiPAP/CPAP
- high-frequency oscillating ventilation
- open suctioning
- sputum induction
- bronchoscopy
- CPR
- autopsy
The Program of Hospital Epidemiology (PHE) recommends that the decision to resolve COVID precautions be discussed by the primary care team in rounds.
Discontinuation of COVID-19 Isolation Precautions criteria:
Asymptomatic, mild, or moderate COVID-19 related symptoms (must meet all criteria):
- At least 10 days since symptoms first appeared (or positive test if asymptomatic)
- At least 24 hours with no fever (without fever-reducing medication)
- Symptoms have improved (e.g., cough, shortness of breath)
Severe to critical COVID-19 illness requiring ICU care or severe immunosuppression (must meet all criteria):
- At least 20 days since symptoms first appeared (or positive test if asymptomatic)
- At least 24 hours with no fever (without fever-reducing medication)
- Respiratory symptoms have improved or stabilized
What is considered a severe COVID-19 illness?
If the patient is in/has been in ICU for a severe COVID pneumonia requiring ventilatory support, then isolate for 20 days. You may make an exception if the ICU stay was brief, no intubation and/or patient condition quickly improved by day 10. We would defer to the clinical judgement of the primary provider/team.
What do you consider severe immunosuppression?
Moderate and severe immunocompromising conditions and treatments include but are not limited to:
- Active treatment for solid tumor and hematologic malignancies
- Receipt of solid-organ transplant and taking immunosuppressive therapy
- Receipt of CAR-T-cell therapy or hematopoietic cell transplant (HCT) (within 2 years of transplantation or taking immunosuppression therapy)
- Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection (people with HIV and CD4 cell counts <200/mm3, history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV)
- Active treatment with high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.
How are isolation dates determined?
The date of the test or the onset of symptoms is day 0. In most cases we use the date of the test as symptoms are subjective. Day 0 through day 10 (or 20) is the isolation period. They are eligible to come out of isolation on day 11 or day 21.
How do I get the COVID-19 infection removed (resolved) from my patient’s chart?
- If your patient requires 10 day isolation: On day 11 after the first + test there is a Best Practice Advisory (BPA) that will fire to providers and if after review your patient meets the criteria you can choose to “Resolve the COVID-19 infection”. If you select the option “does not meet clinical criteria”, the BPA will not fire for another 5 days.
- If your patient requires 20 day isolation: the “does not meet clinical criteria” will need to be selected twice. The third time it fires will be day 21. At that point you can re-evaluate and potentially resolve.
Do I need to talk with the Program of Hospital Epidemiology (PHE) to resolve an infection on a COVID-19 patient?
It is not a requirement to speak with PHE prior to resolving the COVID-19 infection and removing the patient from isolation. We defer to the clinical judgement of the provider. If the timing of the BPA does not allow you to resolve the COVID-19 infection and you have determined that your patient meets criteria to resolve, you can call 356-1606 or page 3158 between 8am-5pm to assist.
If I resolve the COVID-19 infection, what else do I need to do?
Discontinuation of isolation precautions should be the next step. The patient should be in standard precautions (which currently requires eye shield and medical grade face mask) unless otherwise indicated. No special placement required. This should be communicated to the charge nurse or patient’s nurse.
Face shields and eye protection
Eye protection is recommended by the CDC during patient care.
Face shields should be cleaned after each use.
| PPE | Reprocessing Instructions |
| CAPR disposable lens cuff |
Note: Re-used lens cuffs are to be re-used by a single wearer |
| Face shields and goggles |
|
*Envelope: PS#156140
Definitions:
DLC: Disposable lens cuff
CAPR: Controlled Air Purifying Respirator