COVID-19 Updates and Resources – HHSC

By Sandra Frizzell Batton | March 27, 2020 |

The novel Coronavirus has led to outbreaks of respiratory illness in the US. The number of reported cases increases daily. Providers of all types care for some of the most vulnerable Texans, and it is important to stay up to date with all guidance and recommendations from HHSC, DSHS, and the CDC.

PACSTX is regularly in communication with HHSC, sending up-dates to providers, and hosting provider calls. To access this information or to become a member, please reach out to Sandy at sandy@pacstx.org

We know providers are already struggling to recruit and retain staff without COVID-19. To assist, PACSTX is also temporarily allowing members to post jobs on our job bank for free. E-mail Sandy to get the code.

Below are key resources for providers from HHSC.

Personal Protective Equipment Solutions

The World Health Organization has warned of a potential shortage of Personal Protective Equipment including medical masks, hand sanitizer, protective eyewear, gowns and gloves. In the event PPE shortages, use the following as last resort emergency back-ups. These could offer temporary alternative solutions to protect the health of your staff and people receiving services:

Providers should first attempt to obtain PPE through their normal supply chain or through other typically available resources. These options include:

Contacting any sister facilities for coordination
Reaching out to local partners or stakeholders
Looking at any possible reallocations within the Public Health Region, Healthcare Coalition, Regional Advisory Council regions, or other medical supply agencies

Providers who can’t get PPE should follow national guidelines for optimizing their current supply or identify the next best option to care for people receiving services from the provider while protecting staff. If providers are unable to obtain PPE for reasons outside their control, HHSC surveyors will not cite them.

1. Recommendations for Optimizing PPE

For the most current guidance on the use of and how to conserve PPE, access resources from DSHS and CDC.

Hospitals and health care professionals who cannot obtain any PPE from their vendor(s) and have exhausted all alternatives, should send their official requests to their local office of emergency management via the State of Texas Assistance Request process. This is not a guarantee of receiving PPE. Supplies of PPE may be insufficient to meet demand.

Requesting PPE Through Local Emergency Management

STAR is a system operated by the Texas Department of Emergency Management. It allows local emergency coordinators to request equipment and supplies. By working through your local emergency management officials, you can ask them to initiate a STAR request.

Requesting PPE Through a Regional Advisory Council

Each of the 22 RACs in Texas is tasked with developing, implementing, and monitoring a regional emergency medical service trauma system plan. Providers also can contact their RAC to request PPE.

One of the RACs, the Southeast Texas Regional Advisory Council has an online request for PPE. SETRAC serves southeast Texas. If you are served by SETRAC, follow this process to request PPE:

Visit the SETRAC website.
Navigate to the COVID-19 page and forms section.
Complete the form. Include details such as the type of item and number of each item requested, as well as the point of contact for the order.

RAC contacts
Map of RACs
Map of Trauma Service Areas with RAC Names

2. HCP Use of Homemade Masks

When medically approved facemasks are not available, health care personnel might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.

These resources have not been independently endorsed or verified. This does not constitute guidance or a requirement from HHSC.

3. Hand Soap as Alternative to Hand Sanitizer

In settings where there is a shortage of alcohol-based hand sanitizer, use hand soap with pump hand soaps or bar soaps as a last resort.

4. Gloves

Put on clean, non-sterile gloves upon entry into the patient room or care area. Change gloves if they become torn or heavily contaminated.
Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.
HCP should perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that might have been transferred to bare hands during the removal process.
For more information, see CDC Guidance on Gloves

When there is a shortage of medically-approved gloves, use dishwashing gloves or other sturdy protective gloves as a last resort for safety.

5. Extended Use of Eye Protection

Extended use of eye protection is the practice of wearing the same eye protection for repeated close contact encounters with several different patients, without removing eye protection between patient encounters. Extended use of eye protection can be applied to disposable and reusable devices.
Eye protection should be removed and reprocessed if it becomes visibly soiled or difficult to see through.
If a disposable face shield is reprocessed, it should be dedicated to one HCP and reprocessed whenever it is visibly soiled or removed (e.g., when leaving the isolation area) prior to putting it back on.
Eye protection should be discarded if damaged (e.g., face shield can no longer fasten securely to the provider, if visibility is obscured and reprocessing does not restore visibility).

Please see the CDC Guidance on Crisis Capacity Strategies for Eye Protection.

6. Alternative Protective Eyewear

Protective eyewear such as construction or safety glasses with extensions that cover the sides of the eyes, or plastic face shields may be considered as a last option. Following all cleaning and disinfection guidance.

CDC Guidance on Crisis Capacity Strategies for Eye Protection

7. Isolation Gowns

In crisis capacity, the CDC recommends cancelling all elective and non-urgent procedures and appointments for which a gown is typically used by HCP.

Extended Use of Isolation Gowns

Consideration can be made to extend the use of disposable or cloth isolation gowns. This means the same HCP wears the same gown when interacting with more than one patient known to be infected with the same infectious disease when these patients are housed in the same location (i.e., COVID-19 patients residing in an isolation cohort). This can be considered only if there are no additional co-infectious diagnoses transmitted by contact (such as Clostridioides difficile) among patients. If the gown becomes visibly soiled, remove and discard per usual practices.

Re-use of Cloth Isolation Gowns

Disposable gowns are not typically amenable to being doffed and re-used because the ties and fasteners typically break during doffing. Cloth isolation gowns could potentially be untied and retied and could be considered for re-use without laundering in between.

Prioritize Gowns

Gowns should be prioritized for the following activities:

During care activities where splashes and sprays are anticipated, which typically includes aerosol generating procedures
During the following high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of healthcare providers, such as:
- Dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, wound care

Please see the CDC Guidance on Crisis Capacity Strategies for Isolation Gowns for more information.

Staffing for Long Term Care Facilities

During this difficult time period, LTC facilities, LTC owners, and LTC corporations should consider increasing their staffing levels in critical positions for your facilities. This may include CNA’s, food service workers, housekeeping/cleaning staff and other key staff. Consider moving to surge staffing levels or levels at or above 110% of your normal staffing levels. Many people are newly unemployed in your area that can help you meet your current and emergent needs over the next few months. As a reminder, consider in your analysis the amount of time that it takes to train new employees for each key position in your facility.

General Resources

There are many online resources providing guidance on the COVID-19 pandemic. Please access the following websites and resources to promote safety for your staff and the people you serve.

DSHS

COVID-19 Homepage
Information for Hospitals & Healthcare Professionals
COVID-19 Frequently Asked Questions
COVID-19 Local Health Authorities

HHSC

Coronavirus (COVID-19)
Provider Letter 20-21 Suspension of Certain LTCR Requirements During COVID-19 Outbreak

CDC

Coronavirus (COVID-19)
CDC Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings
Resources for Clinics and Healthcare Facilities

EPA

List N: Disinfectants for Use Against SARS-CoV-2

Resources for Long-Term Care Facilities, ICF/IID

CMS QSO 20-20-All Prioritization of Survey Activities
CDC COVID-19 Preparedness Checklist for Nursing Homes and Other LTCFs
HHSC Provider Letter 20-18 Guidance on COVID-19 Response in Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID)

HHSC Resources for Day Activity and Health Services Facilities

Provider Letter 20-14 Guidance on COVID-19 Response in DAHS Facilities