key: cord-0750552-s6489d5o authors: Wickner, Paige; Hartley, Tricia; Salmasian, Hojjat; Sivashanker, Karthik; Rhee, Chanu; Fiumara, Karen; Resnick, Andrew; Mendu, Mallika L. title: Communication with Healthcare Workers Regarding Healthcare Associated Exposure to Coronavirus 2019: A Checklist to Facilitate Disclosure date: 2020-05-07 journal: Jt Comm J Qual Patient Saf DOI: 10.1016/j.jcjq.2020.04.012 sha: aaf3f23f847bb7594f9ff3e0cbadd7a156ba54d4 doc_id: 750552 cord_uid: s6489d5o nan During the current coronavirus 2019 (covid-19) pandemic, healthcare workers (inclusive of all employees who interface with patients, from physicians and nurses to transportation and cleaning staff) are a crucial front-line resource and are at high risk of acquiring the infection. Lessons learned from previous epidemics of middle eastern respiratory coronavirus, severe acute respiratory syndrome, ebola, and avian flu include the importance of protecting healthcare workers from exposure and factors associated with shortfalls in prevention of hospital associated infections. [1] [2] [3] While there are studies from various countries describing efforts to protect healthcare workers during the covid-19 pandemic, related to wearing personal protective equipment (PPE), distancing and handwashing, there have been many reports of healthcare workers infected across the globe. [4] [5] [6] The World Health Organization and the Centers for Disease Control and Prevention have outlined risk assessment and management post-exposure, which includes categorization of risk-level for infection. 7, 8 However, there is limited guidance for healthcare institutions regarding how to communicate and support healthcare workers after a potential exposure. Given the risk from interactions with affected patients and stress associated with providing care, standardized, effective communication to healthcare workers regarding a potential exposure is important. This communication should encompass clear information regarding isolation, self-monitoring, testing and available support for healthcare workers. During this time of crisis and evolving care needs, utilizing a standardized, comprehensive tool like a checklist to conduct complex disclosure conversations is vital. In this commentary, we outline a practical checklist for communication with healthcare workers regarding potential healthcare-associated exposure, to provide disclosure and support (Table 1) . These steps include 1) identifying who will perform the disclosure; 2) initiating the disclosure; 3) providing occupational health contact information; 4) reviewing additional exposures; 5) reviewing symptomatology; 6) providing testing and isolation guidelines based on severity of symptoms; 7) determination regarding when to return to work; 8) identifying and providing needed resources; 9) providing direct contact information for follow-up questions. We detail the various key elements of the process below. As the covid-19 pandemic and number of healthcare workers exposed evolves, institutions will be increasingly coping with disclosure and communication. Given variation in personnel across institutions, it is important to establish which departments (occupational health, infection control, quality and safety, human resources) will be responsible for communicating with and supporting potentially exposed healthcare workers. Creating a robust process allows all parties involved to understand their role and responsibility in investigation and disclosure. Adoption of digital support tools, like self-monitoring reporting, tracking and alert systems, can support operations related to exposures and disclosures. Notably, guidelines continue to evolve, and will depend on the phase of the pandemic, but should be referenced in making timely decisions like work exclusion. Regardless of the specific department and evolution of guidelines, the guidance outlined in the checklist can be tailored to the needs of different institutions. To ensure an effective process, staff trained in providing disclosures is important, and the checklist can facilitate training. Prior to disclosure, investigation into the details of the exposure, preferred language of the affected healthcare worker, and establishing means of communication are necessary to ensure effective communication. At our institution, to avoid further exposure and facilitate rapid confusion. Similarly, understanding potential symptoms, the "where, when, how" of testing, and how to protect family members from exposure, can mitigate the stress that arises from uncertainty. Finally, the question of returning to work and need for isolation may evolve with changing guidelines; disclosure teams should have a clear plan based on updated guidance and lay out the next steps for the healthcare worker. Managers should be provided parallel information to avoid confusion and misinformation. Healthcare workers will have varied financial means and available resources; therefore, providing a list of resources regarding food security, housing security, and transportation assistance is key. 9,10 Social workers can play an important role in this process. Not providing these resources to affected healthcare workers increases the likelihood of community transmission, and results in additional stress on the provider and dependents. For communities in which schools and childcare centers are closed as part of social distancing protocols, resources for healthcare workers with children to continue to work are critical; examples include offering emergency daycare facilities, in-home daycare assistance, and flexibility regarding remote work when possible. Similarly, for some, social distancing within the home may be challenging due to the number of individuals, size of residence, or individuals at higher risk of severe infection. Providing temporary paid housing, for example, in the form of hotel accommodations, may be necessary. In addition, providing psychologic support is of utmost importance, and institutions should provide adequate services to support mental health. Healthcare workers dealing with an exposure have to contend with the risk of illness, loved ones affected, and financial stressors as a result of time away from work, and mental health support can facilitate wellness. Peer support can be helpful, as with other safety events or exposures. Finally, reiterating a clear action plan and contact information as questions arise is important in supporting healthcare workers. The steps outlined in this checklist were developed based on consensus expert opinion and are currently being employed, at our institution. We are using an ongoing healthcare worker tracking and contact program that will inform the utility of the checklist. Although the checklist has not been formally studied, with respect to impact on outcomes, we believe that it can serve as blueprint for other institutions tackling the challenge of expanding community spread of covid-19. During this crisis, ensuring healthcare worker safety and wellness is important to ensure continued resiliency and health of this essential workforce. Recognizing that healthcare workers are among those most vulnerable to illness, and proactively addressing exposures is critical to stemming covid-19 spread. Emphasize the importance of the healthcare worker identifying any patients or colleagues they have been in close contact with recently. Ask t provide a list of individuals to contact regarding possible exposure. Suggested communication: "There may e others, including patients or co-workers, who you have recently been in contact with who may ha been exposed. Please help us to identify any individuals you think may have been exposed. We are happy to reach out to these individuals to h protect themselves and others from further spread of coronavirus." If the healthcare worker is not experiencing any symptoms or only mild (sore throat, cough, fever, etc.) symptoms, emphasize the importance isolating themselves for the next 14 days. This includes protecting family members from exposure. This entails: 1) Staying physically away (6 to 8 feet) from others as much as possible 2) Utilizing a separate bedroom and bathroom if possible 3) Limiting contact with pets 4) Avoiding personal household items (including utensils, towels and personal items) 5) Cleaning "high-touch" surfaces daily* Keep in mind, isolation may present a significant financial and social burden to some healthcare workers. An assessment of the home situation helpful, regarding the number of individuals in the residence and whether there are individuals at higher risk from infection. Be sure to ask if t any resources they need to ensure they can safely and effectively quarantine themselves. If yes, direct them to resources outlined in Step 9. Explain that, should the healthcare worker become symptomatic, they may need to be tested for the virus. Depending on the healthcare system communicating the disclosure, instructions around testing may vary. Most importantly, make sure the instructions are clear, and the healthcare has the resources they need, such as transportation, for testing to take place. If individual does not have the resources required, direct them to resources listed in Step 9. Based on the CDC guidelines referenced below, if a healthcare worker is considered to be at low risk for exposure, they may continue to work monitoring. If considered a medium or high risk, the healthcare worker must be furloughed from work for 14 days after the last exposure. On days healthcare workers are scheduled to work, healthcare facilities should consider measuring healthcare wor ers" temperature and asses symptoms prior to starting work. If they develop fever (measured temperature > 100.0 o F or subjective fever) OR respiratory symptoms, healthcare workers should immediately isolate (separate themselves from others) and notify their local or state public health authority or healthcare facility promptly so they can coor consultation and referral to a healthcare worker for further evaluation. 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Author Mallika Mendu Have a list of local resources that may be able to assist patients with a variety of needs prepared.. Should a healthcare worker voice a concern any of the items below, be sure to communicate how they are best able to access the resources they need. Consider having the contact informa your institution"s social work and/or care coordination department available for additional assistance. Provide healthcare worker with direct contact information of the healthcare institute should any additional questions or concerns arise.