Covid-10 Preparedness and Response Plan
We have carefully considered mitigation procedures and guidance from CDC, AASM, OSHA, MSMS, OSHA, MIOSHA, DHHS, Beaumont Health and others. We have created appropriate policies to ensure patient and staff safety. Sleep apnea is a potentially life-threatening disorder. The Covid-19 virus (SARS-CoV-2) is easy to destroy with low-level disinfection. Central disorders of hypersomnolence may lead to potentially fatal accidents. We stand ready to take care of our patients’ essential and non-essential health care needs safely.
1. General policies:
a. We have developed a COVID-19 preparedness and response plan, consistent with recommendations by Michigan Occupational Health & Safety Administration (MIOSHA), Centers for Disease Control & Prevention (CDC), the American Academy of Sleep Medicine (AASM), and others. The plan is readily available to employees and patients via website and hard copy.
b. Melissa Mancevich, RST, is the daytime worksite supervisor, and Jessica Schoewe, RPSGT, the nighttime worksite supervisor, to implement, monitor and report on the COVID-19 control strategies.
c. Staff has been and will continue to be trained on workplace infection control practices, the proper use of personal protective equipment (PPE), and steps the employees must take to notify the business/operation of any symptoms of COVID-19 or a suspected or confirmed diagnosis of COVID-19, and how to report unsafe working conditions. A record of training will be kept.
d. All employees entering the workplace at the beginning of the work-day must answer a questionnaire covering exposure to and symptoms of possible COVID-19. Upon arrival in the office, all staff must sanitize their hands at the sanitation station in the waiting room. Staff will be asked upon entry about exposure to Covid-19 and Covid-19 symptoms. They will have their contactless forehead temperature taken. A forehead (temporal) temperature 100 F will be considered a fever. Staff with fever or Covid-19 symptoms will be asked to go home in a safe manner. Staff with Covid-19 exposure will be required to be extra diligent about wearing a mask at all times. These questionnaires will be kept in the personnel records.
e. All staff must stay (and must keep patients) at least six feet from one another to the maximum extent possible. Changes have been made to the facilities to allow this.
f. Staff will be provided proper personal protective equipment (PPE), including surgical masks, N95 masks, gloves, goggles and/or face shields, and lab coats, as appropriate.
g. Staff must wear a mask at all times, unless alone in their own room or maintaining six feet of separation from other individuals, in which case the mask may be removed (and re-donned if another individual comes within six feet).
h. Facility cleaning and disinfection has been increased to limit exposure to COVID-19, especially high-touch surfaces (such as door handles, desktops, keyboards, mice, telephones, chairs), and these must be cleaned twice a day, including at workstations and in the waiting room.
i. In the event of a positive COVID-19 case in the workplace, we will clean and disinfect the facility thoroughly using low-level disinfection (which is sufficient to destroy the COVID-19 virus) such as Super Sani-Cloth or Opti-cide Max spray.
j. Hand sanitizer stations have been installed at entrances and throughout the facilities, and cleaning supplies are available to all staff.
k. If an employee has a confirmed case of COVID-19, we will notify (within 24 hours) the local public health department and any staff, contractors or suppliers who may have come into contact with the person with a confirmed case of COVID-19. A record will be kept of this notification.
l. Staff with Covid-19 symptoms will be asked to go home in a safe manner until they have been symptom free for 3 days and it has been at least 10 days since onset of symptoms.
m. We will not discharge, discipline or otherwise retaliate against employees who stay home or who leave work when they are at particular risk of infecting others with COVID-19.
n. If an employee has a confirmed case of COVID-19, we will thoroughly clean and disinfect the facility before allowing patients into the facility.
o. Business-related travel for employees is restricted to essential travel only.
p. Employees are encouraged to use PPE and hand sanitizer on public transportation.
q. We have explored remote work options and remote work for our staff is not possible.
r. As an additional infection-control measure, we have purchased six air purifiers with HEPA filters and UV-C light. These claim 99.97% efficiency in a 167 sq. ft. room which is expected to capture and/or destroy viruses such as the SARS-CoV-2 (the Covid-19 virus). We will use these for PAP titrations in patient bedrooms at night (and during the day for MSLT for patients using PAP), at high speed and UV on during sleep testing. Upon the patient leaving, we will turn them to high speed with the timer set for two hours and the room door closed, which will clear the room with 99.9% efficiency based on 4 air circulations per hour.
s. During periods of high community transmission, we will also use these air purifiers in all other patient bedrooms at night (at low speed with UV light on), and in the 4 exam rooms, testing setup office, and waiting room during the day (on patient days) at low speed with UV light on.
2. Outpatient health-care facility specific policies:
a. We have posted signs at entrances informing patients that they must wear a face covering and come alone (with exceptions for children, and patients with disability or cognitive impairment, who are allowed one companion) in order to enter. We will provide patients without a face covering with a cloth mask (at least double-ply) for the duration of their stay with us. We will launder the mask before reuse. Patients must keep their face covering or mask (with nose, mouth and chin covered) on at all times. They may remove this when alone in their bedroom, but must put it back on before leaving their bedroom.
b. We have limited waiting-room occupancy to allow patients to stay six feet from each other.
c. We removed enough chairs to limit waiting room occupancy as well as occupancy in examination rooms, and to allow a distance of about 6 feet between individuals. This has involved removing the chairs in the exam rooms, 50% of the chairs in the waiting room, 67% of the chairs in the conference room, and a couple staff chairs.
d. Sign-in is now contactless, with a staff member signing in the patient. Clipboard used for patient questionnaires will be placed in an open bin and reused after 72 hours (since SARS-CoV-2 may survive on hard surfaces for 48 hours). Used pens will be placed in an open bin and undergo low-level disinfection at the end of the day before reuse.
e. We have added special hours for highly vulnerable patients, including the elderly and those with chronic conditions.
f. Upon arrival in the office, all patients (and companions, if allowed) must sanitize their hands at the sanitation station in the waiting room. Patients (and companions, if allowed) will be asked upon entry about exposure to Covid-19 and Covid-19 symptoms. They will have their contactless forehead temperature taken. A forehead (temporal) temperature ≥100 F will be considered a fever. Patients/ companions with Covid-19 symptoms or a fever will be rescheduled until they have been symptom free for 3 days and it has been at least 10 days since onset of symptoms. Patients/ companions with Covid-19 exposure will be required to be extra diligent about wearing a mask (not just a face covering). Do not schedule patients for testing if they have exposure to Covid-19 in the last 14 days or have Covid-19 symptoms, until 14 days past exposure and 3 days past resolution of symptoms (and 10 days past onset of symptoms).
g. We have installed several hand sanitizing stations throughout the facilities including at entrances. These will allow patients to sanitize their hands frequently.
h. Staff must make proper use of personal protective equipment (PPE). Staff must wear a surgical mask at all times, unless alone in their own room or extended work area with no one else within 6 feet. Surgical masks may be removed intermittently and stored in a paper bag labeled with the staff name. The surgical mask must be discarded if it breaks, becomes soiled, or no longer fits, and must be discarded daily. Staff working within 6 feet of patients must wear a surgical mask and a face shield or goggles. During procedures causing aerosolization (such as being in the same room with a patient actively using a Positive Airway Pressure [PAP] device), staff must wear N95 mask, goggles or face shields, and gloves. N95 masks may be removed intermittently during the day as necessary and stored in a paper bag labeled with the staff name. They may be sanitized four times with steam (2 min in a steamer with 2 oz. of water, in a microwave at high power), and reused four times (4 days) for a total of 5 days of use. However, they must be discarded if broken, soiled, or no longer fitting. Goggles and face shields may be washed with soap and water, or sanitized with alcohol wipes or Super Sani-Cloth. Gloves must be discarded after use. Staff must wear lab coats at all times, and we must launder these daily.
i. Patients (and companions, if allowed) must properly wear a mask or face covering that covers their nose, mouth and chin. If they do not have a mask, we may provide them a cotton double-ply mask, which we will collect when the patient is leaving, and launder daily.
j. There is a physical barrier (a countertop and wall with a glass windows that can be closed) at sign-in/temperature screening.
k. Telehealth services will continue to be available (for established patient but not for new patient or testing follow-up appointments) and may be scheduled during established patient slots. However, insurance companies currently plan to stop covering them sometime in June (with exact date depending on insurance company), so patients will then have to pay.
l. The patient schedule allows maintenance of social distancing and cleaning between patients for the number of rooms available.
m. Patients with fever or Covid-19 symptoms will be rescheduled unless they need emergent care, in order to avoid exposing other patients.
n. We will clean any examination room, hookup-up room, and testing room area and equipment that comes into contact with patients, in between appointments. We will continue high level wet heat disinfection of CPAP masks and tubing, intermediate level disinfection (using Super Sani-Cloth with 2 min contact time) of thermistors, and low level disinfection (using Super Sani-Cloth with 2 min contact time) of HSAT devices, PSG equipment, and other testing materials, following our established protocols, and be even more diligent. Low-level disinfection kills the SARS-CoV2. For patient bedrooms during PAP titration or use, we will also use air purifiers with 99.97% efficient HEPA filters and UV-C light that are expected to capture and/or destroy viruses such as the Covid-19 virus, at high speed with UV on during sleep testing. We will continue use at high speed with UV on for two hours with door closed after the patient leaves for the day, allowing for 99.9% efficient clearing of particles based on 4 room air circulations per hour. Staff must clean their work area (including desk, keyboard, mouse and telephone twice daily.
o. If an employee or patient is found to have suspected or confirmed Covid-19, the facilities will be thoroughly disinfected (using low-level disinfection with Super Sani-Cloth with 2 min contact time or Opti-cide Max spray with 1 min contact time. This is sufficient to destroy the Covid-19 virus. Reported drying time is 3 min for alcohol plus quaternary ammonium compound preparations such as these.).
p. When community transmission of Covid-19 is high, and subject to availability, we will perform Antigen Rapid Testing using a product with EUA, on all patients being tested on PAP, before admitting them for testing. If they are positive, we will cancel the testing. If they are negative, we will perform testing, in which case no special precautions (such as in para 2h and 2n) other than for all patients being tested will be necessary for these patients.
We will review these policies constantly. We will add or modify these policies as necessary. With these policies and with diligent staff, we will take care of our patients and their essential medical needs safely.
R. Bart Sangal, MD
December 5, 2020