Dear Patients of Great Lakes Eye Care,
We want to assure you that Great Lakes Eye Care is here to provide you with the highest quality of care as we continue to monitor reports of the potential impact of the Coronavirus (COVID-19). During this time, our top priority is the health of our staff and patients.
Please see our policy below:
Great Lakes Eye Care COVID-19 Policy
June 10, 2020 edition
COVID-19 – What we Know:
· This virus is primarily spread through respiratory droplets. It can also remain on surfaces and be transmitted from hand to mucus membrane (nose, mouth, or eyes).
· Most patients have flu-like symptoms. There is some disease spread by people with minimal to no symptoms. Patients with more symptoms are likely more contagious.
· The average number of days from contact with the virus to onset of symptoms is 5.1 days.
· 80% of our patients are at increased risk of death (over 60 years of age) from COVID-19.
· We can slow the process with social distancing, thereby reducing the chance our hospital system becomes overwhelmed by doing our part to "flatten the curve.”
· Our services are vital for preserving vision.
· A vaccine is potentially on the way.
1. To preserve and restore eyesight in our community. During this pandemic we want to help reduce the likelihood of our office being a vector for virus spread. We will balance patient volume with staff and patient safety, maintaining social distancing as much as we can with our job duties.
· Enable employees to work remotely from home if their job tasks allow them to do so.
· Wipe all surfaces (examples include the door handle, patient chair, and slit lamp) after each patient. Cut cavicide wipes in half (given current shortage). Keep wipe in a container to hinder evaporation.
· Remove shared items around the office, including pens, coffee centers, patient refreshments (cookies), container of mydriatic glasses, multi-use lens cloths, toys, magazines, etc.
· Place an employee at the front door of each office to screen all patients and visitors. If a patient has any respiratory or flu-like symptoms, yet must be seen, the “COVID-19 suspect” protocol will be followed (see below).
· Require all GLEC staff and Doctors to check their temperature and fill out the self-monitoring questionnaire at the front door or employee entrances.
· Space all chairs in the waiting room at least 1 meter apart.
· Disinfect all waiting room chairs after each use.
· Create multiple check in/out stations at the St. Joseph office to decrease patient congestion in one area.
· Practice social distancing rules (keeping a distance of 6 feet between staff member and patient or staff member and staff member) as much as possible.
· Staff will eat lunch outside the building in their cars or at isolated work stations if their job duties allow it.
· Patients are limited to one visitor/companion who is providing transportation to the patient receiving care. If the patient is capable of being alone, we will ask the visitor/companion to wait in the car.
· Place gel hand sanitizer dispensers at every workstation and by every employee entrance.
Personal Protective Equipment (PPE) protocol:
· All GLEC team members, regardless of position, will be required to wear a mask at all times when working, be it an N-95/KN-95 or a surgical mask. See below the “GLEC Mask Safety Acknowledgement”.
o Consistent or wanton failure to adhere to these policies will result in GLEC disciplinary action, including but not limited to; verbal warning, written warning, suspension or termination of employment.
o Wearing a mask is not necessary if working in a segregated/secluded area or private office.
· All patients and necessary companions who are not wearing a mask or face covering when screened at the front door, will be given a donated cloth mask or surgical mask.
o Exceptions can be made for special situations; baseline shortness of breath, claustrophobia, mental status, or very young children are examples. Please ask the triage doctor (BPN or DNB) or safety officers (listed below) if you have questions.
· Clinical staff (techs, scribes, opticians, nurses and doctors), working in the “T-zone”, (medically defined as the area where the ears, eyes, nose, and mouth are located) will have the option, and encouraged, to wear N-95/KN-95 masks. Each individual will be given two N-95/KN-95 masks weekly: one to wear for the morning and one to wear for the afternoon.
o N-95/KN-95 masks will be labeled with the user's name and date.
· Non-clinical staff will wear surgical masks. Surgical masks will be used for one day and then discarded.
· All staff will have the option to wear N-95/KN-95’s if that is their preference, at this point in time.
· Use proper hand hygiene (hand wash or sanitize) when putting on or taking off any mask.
o The outside of the mask must always be considered contaminated.
· According to most recent studies, COVID-19 cannot withstand temperatures of 158 degrees or higher for long periods of time. Therefore, designated RN staff will "bake" N-95/KN-95 masks in a special warmer set at 158 degrees for 30 minutes before they are placed in a labeled storage system. Metal strips on masks will be wiped with alcohol prep pads after baking. This will occur within a special room (the 20-foot lane) dedicated to storing “used masks” overnight. This will be done for AM masks after the morning shift is complete and for PM masks at the beginning of the next work day.
· All clinical staff, working in the “T-zone,” should wear eye protection (e.g. safety glasses found in the bottom drawer of the tech counter. Regular prescription glasses “count” as eye protection). If safety glasses are used, they should be sanitized and returned to the bottom drawer of the tech counter at the end of the day.
Team Member Exposure to COVID-19:
Anyone who has been exposed (defined below) to someone who is confirmed with or presumed to have COVID-19 should self-monitor for COVID-19 related symptoms for 14 days. While you are self-monitoring, you can continue to work as long as you do not have symptoms.
· A fever > 100°F
· Worsening shortness of breath in the last 48 hours
· Worsening cough in the last 48 hours.
If any of these symptoms exist, please contact your supervisor.
A “team member exposure” has occurred when you have interacted with an individual who is confirmed with or presumed to have COVID-19
· AND you were not wearing appropriate personal protective equipment,
· AND the COVID-19 individual was not wearing a mask,
· AND you were within 6 feet of the individual
· AND the duration was for 10 minutes or longer.
COVID-19 suspect protocol:
· A clinical staff member wearing protective equipment will be placed at the main entrance of the office. Every patient will be asked to use the nearby hand sanitizer station and the following screening questions will be addressed to every patient. In the last 14 days, have you:
o Had a fever, cough, shortness of breath?
o Had close contact with someone who is suspected to have or has COVID-19?
· Temperature will be taken.
· If the answer to any of these questions are positive, or if the temperature reading is over 100, and they have need of immediate evaluation, they will be instructed to call (269) 428-3300 to speak with one of our clinical staff. After speaking with the patient, our triage doctor will determine appropriate treatment.
o Most patients will be asked to reschedule after 14 days from the day of cancellation.
o Exceptions could be made for; patients suspected of macula-on retina detachment, neovascular glaucoma, complications of recent surgery done by a GLEC surgeon, and other conditions deemed necessary by the triage doctor.
· If the patient requires a companion, the above questions and temperature screening will be required of the companion as well.
· The patient’s chief complaint will be obtained. The patient will specifically be asked if they are here because of red eye or pink eye type symptoms. If the answer is yes, the red eye protocol described below will be followed.
Red Eye Protocol:
· Room C-3 has been designated as the “red eye” room.
o The patient will be screened as described above.
o If the chief complaint is a “red eye,” the following protocol will be implemented.
· The clinical staff member at the front entrance will have the patient put on a mask (a procedural mask if a cloth mask is not available), will bring the patient directly to the “red eye” room (C-3) using social distancing rules, and the patient will stay in this room. (As a back-up, H-11 may be used as the “red eye” room.)
· The technician will take the history and evaluate the patient wearing a mask, gloves, and goggles.
· Visual acuity will be checked and the patient examined grossly for signs of COVID-19 related eye infection or contagious conjunctivitis.
· If there is a clear history of iritis and the gross examination supports the diagnosis of iritis, the IOP can be checked. Otherwise, IOP will be deferred until after the doctor examines the patient.
· A member of the scribe team will assist the doctor during the examination as per routine.
· If the patient is deemed contagious, the scribe team will use social distancing rules to help escort the patient out of the building directly without checking out at that time. Appointment scheduling and billing will be completed by phone after the patient leaves the building.
· The room and any other patient contact points in the office will be disinfected.
Returning to Work After Illness Policy:
Please talk to your supervisor about your illness and symptoms. Your supervisor will relay your symptoms to one of the clinical specialists (Dr. Cooke, Dr. Brown, or Shelby Weaver, RN) to determine whether or not you are option 1, 2, or 3. (See below.)
1. If there is a high likelihood the illness is NOT COVID (seasonal allergies, mild cough or sneezing or runny nose consistent with typical allergies, etc):
1. Return to work as soon as cleared by clinical specialist.
2. If there is a reasonable chance the illness is NOT COVID:
1. Return to work 3 days after the end of symptoms.
3. If there is a reasonable chance the illness IS COVID, or it is positively diagnosed as COVID:
1. Return to work 3 days after the last episode of fever without the use of fever-reducing medication and a reduction of respiratory symptoms, and at least ten days have passed since the onset of symptoms.
**If it cannot be determined reasonably whether or not the illness is COVID, and the employee is determined to be critical to the clinical function of GLEC, the shortest option in this workflow will be followed.
***A team member who has been exposed to someone, such as a household family member, who is suspected or confirmed to have COVID-19 should self-monitor for COVID-19 related symptoms for 14 days. However, while self-monitoring, the team member will continue to work as long as they do not have symptoms.
GLEC Mask Safety Acknowledgement (6-8-20):
Great Lakes Eye Care is committed to the safety and well-being of our staff and of our patients. The information and scientific data regarding the benefits of wearing masks in reducing the transmission of COVID-19 is evident but evolving. From what we know at this point in time, both N95/KN95 masks and procedural masks (surgical masks) provide significant protection and reduction of viral transmission. A review of the available data reveals that wearing a well-fitted N95/KN95 mask provides greater protection and safety for both the wearer and others than does wearing a well-fitted procedural mask. Regardless of the type of mask, safety is significantly reduced and the risk of viral transmission and infection is increased when the mask is ill-fitting and when significant donning, doffing, and touching of the mask occurs. Because of this, we recommend that our team members who have close, direct contact with patients (providers, nurses, technicians, scribes) choose to wear a well-fitted N95/KN95 mask. However, given the fact that a well-fitted procedural mask may provide equal or perhaps better protection and safety than a poorly-fitted N95/KN95, we will allow each team member who is in close, direct patient contact to choose to wear a well-fitted procedural mask in place of an N95/KN95 that they deem ill-fitting. We ask that donning, doffing, and touching of masks of any type be kept to an absolute minimum. All GLEC team members, regardless of position, will be required to wear a mask at all times when working, be it an N95/KN95 or a procedural mask. (An exception may be acceptable when a team member is working solo in an area isolated from others.) Cloth masks will not be permitted. Given the continued severe shortage and reduced availability of all types of medical masks and PPE, we will continue our current mask reuse policy, utilizing low-heat sterilization. Our policies will surely change as things unfold, both from changes in our understanding of the scientific literature and from our ability to acquire new supplies of PPE.
· I understand and acknowledge that an N95/KN95 mask provides me greater safety and protection than does a procedural mask.
· I understand and acknowledge that I must wear an N95/KN95 mask or a procedural mask at all times while working.
· I understand and acknowledge that the more times I take on and off and touch my mask, the greater risk I have been exposed to and possibly infected by any virus, including COVID.
Great Lakes Eye Care COVID-19 Training Acknowledgement Form:
I acknowledge that I have been adequately trained on the following topics regarding COVID-19. I acknowledge that I understand the importance of adhering to my training in order to minimize my potential exposure to COVID-19, as well as minimizing the potential exposure of my patients and co-workers.
· Modes of transmission of COVID-19
· Signs and symptoms of COVID-19
· The identity of GLEC/GLSC COVID-19 safety officer(s) and their responsibilities
· Workplace infection control practices (review of GLEC/GLSC COVID-19 policy)
· How to properly use the PPE provided to me by GLEC/GLSC
· What to do if I have a suspected or confirmed diagnosis of COVID-19
· What happens if I violate GLEC/GLSC COVID-19 safety policies, including disciplinary action and possible termination of employment
· How to report violations of infection control practices to the Safety Officer
· How to report unsafe working conditions to MIOSHA
· This form will be signed by all employees.
· Safety officers; Shelby Weaver, Jim Duryee, Jennifer Adams, Jennifer Zech, Ellen Napier, Jackie Edelberg
· Reporting unsafe conditions to MIOSHA outside of reporting within GLEC - https://www.michigan.gov/leo/0,5863,7-336-78421_11407-93835--,00.html