COVID-19 Testing for Patients Undergoing Aerosol-generating Procedures

In this rapidly changing environment of management of COVID-19, maintaining patient and staff safety is of utmost importance. In an effort to efficiently treat patients and protect all healthcare workers, UW Medicine has established guidelines for testing prior to aerosol-generating procedures (AGPs). Specifically, patients (with or without symptoms of acute respiratory infection) who are undergoing an actual or potential AGP (e.g., intubation, extubation, transesophageal echocardiography, endoscopy, etc.) should be tested whenever possible prior to the procedure.

For patients undergoing same-day surgery or outpatient procedures, testing should be performed within 72 hours of the planned procedure. If testing is truly not possible, a rapid test may be considered on day of surgery, but this availability is extremely limited, will lead to delays in non-emergent cases, and is reserved for urgent or extenuating circumstances.

For more details, please review the following documents on our UW Medicine COVID-19 website:

Personal Protective Equipment (PPE) Substitute Validation Process

Given the current high demand for PPE and other patient care supplies, many of our usual supplies are very limited or unavailable. With guidance from Infection Prevention and clinical leaders, UW Medicine Supply Chain has prioritized exploring all reasonable supply substitutions for the system. This has included seeking out alternate or substitute equivalent products for PPE and other patient care items.

Prior to purchase and implementation, all substitute products are compared to each of our hospitals’ product(s) and carefully evaluated for equivalency and appropriateness by the UW Medicine Incident Command Allocation team, which includes clinicians with expertise in PPE. All potential substitute items that have not been used within our system are carefully reviewed by the relevant clinical experts from Infection Prevention, Respiratory Therapy, and/or Nursing. This process has enabled us to make efficient decisions on substitute products and keep critical supplies in stock throughout our care areas during this unprecedented time.

Staff can expect to see variations in PPE items and patient care items over the next few months, and sometimes these items may be stocked in your area without formal notification. If you have concerns about the substitute products your department has received, please raise this with your department or nurse manager for further review.

Optional Extended-Use Masking Policy for Healthcare Workers

Last night, we began the roll-out of the new UW Medicine Optional Extended-use Masking policy. We started in the UW Medicine Emergency Departments and are currently working on the implementation in all other areas (including clinics).

Why are we making this change?

1) Concerns of staff and clinicians: We heard your concerns as we see more cases of COVID-19 and understand that many staff and clinicians are uncomfortable coming to work without additional personal protective equipment (PPE). We also recognize that people may be infected without having symptoms or with very mild symptoms. We want our healthcare workers to feel safe and confident as they continue to respond to this pandemic.

2) Personal protective equipment (PPE) conservation: Those who opt in will be wearing one mask per day and will use a face shield when going into patients in droplet/contact (in addition to gown and gloves). Each healthcare worker will use one face shield per shift, which will be cleaned after each patient and discarded at the end of their shift.

This decision was not made due to an exposure or a change in the rate of infections among UW Medicine staff or faculty. In fact, we are reassured that, as of today, 4.4% of all symptomatic UW Medicine employees out of over 2,000 individuals have tested positive for COVID-19 compared to 9.8% of all patients tested in the UW Clinical Virology Lab. We will continue to do all we can to support a safe work environment for our employees and appreciate your continued input and partnership. Please see our policy statement and FAQs on the UW Medicine COVID-19 website for more information.

COVID-19 Testing Strategy

UW Medicine continues to evaluate and evolve COVID-19 testing capabilities to meet the growing needs of UW Medicine patients.

A fifth UW Medicine drive-up site opened at the UW Neighborhood Issaquah Clinic on April 1.  This additional site will provide COVID-19 testing for UW Medicine patients who have an order for the coronavirus test from their provider. The other testing sites are as follows: Two UW Medicine drive-up testing sites are located at University of Washington Medical Center – Northwest, one at Valley Medical Center and one at Harborview Medical Center. UW Medicine continues to assess options for setting up additional sites, especially for vulnerable patient populations.

“These drive-up testing sites are important on many levels,” said Debra Gussin, Executive Director of UW Neighborhood Clinics. “First, they keep patients who are potentially infected out of our hospitals and clinics where they might expose others to the virus. Second, this is a very convenient way for those suspected of having the virus to be tested quickly and easily, without leaving their cars.”

The drive-up testing clinics also help conserve valuable personal protective equipment (PPE) by eliminating the need for providers to continuously change masks and gowns. Patients are pre-scheduled and arrive at an appointed time.  A nasal swab is taken and patients are provided with a QR code to use to obtain their test results.  Results are typically available within 10 to 17 hours. About 80 percent of COVID-19 cases experience mild symptoms that can be treated at home. 

UW Medicine has seen a dramatic increase in the number of COVID-19 related calls. To better help with patient symptom assessment, UW Medicine worked with Amazon to develop a virtual assistant to help streamline the process for UW Medicine patients seeking advice and guidance.

“There are a lot of concerned individuals in our community who are worried they have COVID-19,” said Carrie Priebe, Senior Director of Access and Innovation. “We needed to find a way to triage these patients quickly so we could provide those who don’t need testing peace of mind, and for those who do need testing the opportunity to do so as soon as possible.  The virtual assistant is available 24x7 and takes the patient through a series of questions regarding their symptoms and other known risk factors.  When finished, they are either given the needed reassurance or connected to UW Medicine for scheduling a COVID-19 test or a virtual appointment with one of our providers.”

UW Medicine’s goal is to use the virtual assistant and drive-up testing sites as a streamlined approach to evaluate and test for suspected COVID-19. 

The COVID-19 pandemic has also made it necessary to temporarily suspend operations at three Urgent Care Clinics at Issaquah, Ravenna and Shoreline until May 1, 2020. The Ballard and Federal Way Urgent Care Clinics will continue to see patients, seven days a week through telehealth, as well as in-person care when necessary.

UW Medicine continues to evolve its response to COVID-19 as leaders evaluate the best ways to screen patients and preserve PPE while keeping our patients and staff safe.

Well-Being and Support

As the weeks pass, we find ourselves not just experiencing the stress and anxiety of navigating COVID-19, physical distancing, clinical realities, and the impending surge of cases in our community – we are also struggling with the grief at the loss of our routines and what we had been looking forward to: travel plans, birthdays, graduations, and the celebrations in life that pass by on our calendars as if belonging to a different reality. 

There will be a time in the future beyond this pandemic, but the distance between now and then is challenging to wrap our minds around.  We often keep something on the horizon to look forward to, but that horizon keeps moving.  The uncertainty we are experiencing now can be overwhelming. 

This week we want to focus on taking control of stress and anxiety and coping with uncertainty by leveraging resilience during COVID19. Psychologist Dr. Lisa Damour encourages us to realize that anxiety is a normal and healthy emotion that helps alert us to the need to protect ourselves. Here are a couple reminders from Dr. Damour of what you can do to help yourself and those around you: 

  • Adopting new, temporary routines will help to reduce overall stress. Decisions are mentally taxing; having routines reduces the number of decisions we make each day. COVID-19 has upended many regular routines and increased decision-making stress.
  • Major stressors, such as COVID-19, cause a cascade of microstressors, such as worries about how to get a haircut. Microstressors add up over time to become a significant source of stress. You can take the pandemic seriously while addressing microstressors. And tackling microstressors will be key to managing stress over the long run.
  • When stress increases, we need and deserve more support. If you can't reduce your stress right now, work on the other side of the equation by seeking the help you need. Get emotional support by connecting with the people you love and use the resources listed below.

Know that teams across UW Medicine and the broader University have been working to help provide support for you and your families. For up-to-date information on child care, Friday Town Halls, Care & Share offerings, free parking, Peer to Peer Support, and Department of Psychiatry support for our faculty and staff, please continue to check our Well-Being and Support website.   

Know that during this challenging time, our community is behind us.  We’ve received over 330,000 items of personal protection equipment (PPE), food (including from Lizzo), financial donations, and over 1,200 messages of encouragement in the last week, including this one that captures what much of our community hopes to convey:  

“To our friends at UW Medicine, thank you for everything you are doing. You are leaving your houses each day with courage and bravery, and your Seattle community sees you and appreciates you. We see your sleepless nights, your long shifts, and your dedication to and love for strangers. From the new babies being born to the oldest patients, the love and care you're providing is uplifting to all of us who feel helpless…From our homes, we hope we are helping you heal the world.” – Anonymous

The horizon that we are hoping for may feel very far away, but we are building toward it together one day at a time.

Roll-Out of Extended-Use Masking for Healthcare Workers

The safety of every UW Medicine patient, staff, trainee and faculty member is our top priority. As the COVID-19 pandemic continues to rapidly evolve and new information becomes available, we have carefully considered the optimal strategies to ensure the safety of our patients and workforce, anticipating short and long-term needs. We have also heard your concerns and want our workforce to feel safe and confident as they continue to respond to this pandemic.

Last night, we began a roll-out of extended-use masking for healthcare workers at UW Medicine. We began in the Emergency Departments with plans to then expand to other clinical areas over the next 24 hours. The planned schedule is as follows:

  • Last night: We began roll-out in UW Medicine Emergency Departments.
  • This morning: Receive feedback on mask utilization, implementation, and staff safety from ED team.
  • Later today: Front door screeners, security, nutrition and food services, and all hospital units and clinics.

Why have we decided to transition to allow extended-use masking of healthcare workers?

We are continuing to learn new information as the COVID-19 pandemic evolves and are foremost focused on the safety of our healthcare workers. Currently, there is widespread community transmission of SARS-CoV-2, the virus that causes COVID-19, in our area. While COVID-19 is predominantly spread by large respiratory droplets produced when a person coughs or sneezes, we are learning that patients may be infected without having symptoms or prior to developing symptoms. Sometimes these symptoms can be mild leading to a delay in recognition in both ourselves and our patients.

We have heard your concerns and understand that many staff and clinicians are uncomfortable coming to work without additional personal protective equipment (PPE). We want our healthcare workers to feel safe and confident as they continue to respond to this pandemic. This change is made based on the continued expansion of the local COVID-19 epidemic and is contingent on our ability to maintain adequate PPE supplies. Please note that the ability to receive additional supplies of masks is not assured, and all staff are entrusted with thoughtful and judicious use of their masks as part of our PPE conservation strategy.

We are reassured that so far only 4.4% of all symptomatic UW Medicine employees, out of over 2,000 individuals, have tested positive for COVID-19 compared to 9.8% of all patients tested in the UW Clinical Virology Lab. We will continue to do all we can to support a safe work environment for our employees and appreciate your continued input and partnership.

Here are some key points to think about as you prepare for optional extended-use masking:

  • Each healthcare worker who decides to wear a mask outside of direct patient care will be issued a single procedure mask at the beginning of their shift. These masks will be worn for the duration of the shift.
  • A mask will be worn continuously unless it becomes wet or soiled.
  • When interacting with patients on droplet/contact precautions, a face shield should be worn to protect your eyes and the mask.
  • Masks should always cover the nose and chin when worn.
  • Hand hygiene must be done before and after touching your mask.
  • Your mask should be stored in a clean and dry place when eating or drinking.
  • For all, whether masked or not, there will be no more eating or drinking in patient care areas or within 6 feet of another person.

As we prepare for a surge in patients over the next several weeks, we will continue to learn and make adjustments to our policies for your safety and the well-being of our patients. For more information, please read our UW Medicine Extended-Use Masking Policy.

Thank you for all of your contributions to our difficult and vital response to the COVID-19 pandemic.

UW Medicine Work-Related Travel Restrictions Extended to May 1, 2020

UW Medicine is extending its restrictions on all work-related travel for all employees until May 1, 2020. These restrictions were first announced by Dr. Paul Ramsey, CEO, UW Medicine, on March 8, 2020, and they include all travel for conferences and meetings related to professional membership societies and associations as well as meetings or gatherings related to grants.

The extension of travel restrictions is aligned with Gov. Jay Inslee’s Stay Home – Stay Healthy proclamation and the University of Washington’s restrictions on international travel for all faculty, staff and students.

In addition, UW Medicine encourages employees to avoid nonessential personal travel during this global pandemic. As we prepare for a possible surge of patients locally and see the spread of COVID-19 across the country and world, social distancing remains our best strategy to protect ourselves and our community.

You can read the full updated travel restriction memo here.

Free Child Care Offer From Bright Horizons: Limited Availability

We have a new offer for free child care for healthcare providers. This is a first come, first-served opportunity and not unique to UW or UW Medicine. Please reach out soon as availability is limited.

What Is Offered: Bright Horizons is partnering with First Responders First to operate FREE fully-funded child care for essential workers in centers located in close proximity to healthcare hubs, including Bright Horizons at 101 Sixth Ave. S., Seattle, WA, 98104 (Pioneer Square). There are a total of 40 spaces available on a first come, first-served basis. Here is a link to a flier with more details about this center to share with your employees

In addition, we have been able to streamline access to child care resources for UW healthcare workers through one process: 

  • Healthcare workers at UW Medicine clinical sites who need child care should call the Child Care Aware COVID Referral Center.
  • The Referral Center can serve callers Monday through Friday, 8:30 a.m. to 4:30 p.m., and in their home language.
  • The Referral Center will connect families directly to vacant child care slots in the community, including those available only to UW employees.  

Here’s how the process works: 

  • Call 1.800.446.1114.
  • Press “1” to request child care.
  • Press “1” to indicate you are a healthcare worker/first responder.
  • Tell the operator you work at a UW Medicine clinical site.

Learn more about the process here.

We Are One Team When It Comes to Staffing Against COVID-19

Thank you for all the work you are doing to care for our patients with COVID-19, to support one another and to prepare for the anticipated increase in number of patients who will require our care over the next several weeks.

As shared in previous all-staff emails, leadership has been preparing for the surge of COVID-19 patients expected in the coming weeks. Our intent is to protect everyone’s safety, support each other, and care for our patients and community in this unprecedented crisis. Because it will take all of us working together in new ways to be successful in a major surge, we want to make sure that you understand and are prepared for possible new roles and responsibilities. 

Everyone has a role in centralized staffing
We rolled out the structure of centralized staffing with all managers and are ready for implementation. By now, most of you should have had a conversation with your manager laying out the key components and how you might be asked to work outside your regular team. It’s critical that everyone is ready to jump in and help where most needed and most appropriate. There will be times when you will be tapped to move in quickly to meet a growing need. You will be provided "just in time" training for any new role as well as ongoing support.

Working from home is unlikely for many in a surge
Even if you have been told by your manager that working remotely was an option, new roles and responsibilities under the centralized staffing model may require that you work at one of our medical facilities. The UW announcement last week stating that teleworking is mandatory for employees does not apply to UW Medicine employees who are or may be called to work to address the growing COVID-19 health crisis. 

This is an unprecedented time with unique challenges every day. We have been humbled by the work everyone in the UW Medicine system is doing. We are all learning as we go and we will continue to do so. This community inspires us and we are incredibly grateful for all you are doing to support our patients and each other.

COVID-19 Case Count, PPE Conservation Strategy and Teleworking Guidelines

The COVID-19 pandemic continues to significantly impact our region and country. Significant progress is being made on surge planning, central labor pool, personal protective equipment (PPE) acquisition and conservation, and testing capability expansion.

This update includes a summary of case counts for UW Medicine hospitals, UW Virology Lab activity, new protocols and policies, as well as important announcements.

UW Medicine Hospitals’ Case Activity as of March 28, 2020, 8 a.m.:

Case activity table

UW Virology SARS-CoV-2 Testing Activity: On March 27, 2020: 2,000 samples were completed. Current daily capacity is 3,000 samples. Turnaround Time: 8 hours. No current backlog.

New and Revised Protocols and Policies:

  • NEW: UW Medicine Critical Care Management of COVID-19 (March 24, 2020)
  • NEW: Guidelines for the Physical Examination of the Patient who Has Suspected or Confirmed COVID-19 (March 26, 2020)
  • Revised: UW Medicine SARS-CoV-2 Treatment Guidelines (March 25, 2020)

Important Announcements:

Conservation Strategy for Face Masks with Integral Eye Shields: The dynamic state of our supply chain for personal protective equipment (PPE) requires that we enact conservation policies that include suitable and safe substitutes. We are currently experiencing low supplies of facemasks with integral eye shields at all four hospitals.

Per our conservation policy, we are in the process of providing staff on the inpatient units with rigid hard-sided goggles or full-face shields that are safe to clean and reuse if not damaged. This eye protection is coupled with a separate mask in order to provide complete facial protection. Staff on the inpatient units at each hospital have received more information on this conservation strategy directly from leadership, including details on each unit’s allocation and instructions for inspecting and cleaning the replacement googles and face shields.

Our supply chain colleagues have secured substantial supplies of reusable face shields for our care teams. In addition, our community of UW innovators led by Beth Ripley, Dmitry Levin and Rob Sweet has begun 3D-printing production of FDA-approved face shields with both reusable and disposable components and will begin testing mask designs followed by potential gowns and ventilator parts.

New Teleworking Guidance: We are seeing a rise in malicious attacks as negative actors exploit COVID-19 to target teleworkers and staff eager for information. UW Medicine Compliance and Security updated their guidance into a quick reference guide that all staff are encouraged to review and implement immediately.

Key takeaways:

  • Maintaining patient privacy is a priority even when working from home.
  • Use designated resources for accessing UW Medicine systems and storing confidential information. You can find those listed in the quick reference guide.
  • Protect access to your computer by locking it or logging out when unattended.
  • Be aware of your surroundings when discussing confidential information - either on the phone or video conference call.
  • Check links and senders before opening hyperlinks or attachments. Be on the lookout for fake COVID-19 websites and phone scams.

Most importantly, we continue to be inspired by our UW community in response to COVID-19. Thank you for everything you are doing to keep each other and our patients safe. Your efforts are greatly appreciated.