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Restarting patient & client services at PHC

COVID-19 RECOVERY INFECTION CONTROL KEY PRINCIPLES AND CONSIDERATIONS - AMBULATORY CARE

May we continue to book virtual visits for our patients/ clients?
Virtual visits and telephone-consultation should be prioritized over in-person appointments when appropriate to reduce the patient flow in the clinic. 

For cleaning and disinfecting electronic devices, follow the PHC Guidelines for Cleaning and Disinfection of Equipment/Devices/Surfaces.

What is the process for in-person patient/ client visits?
Initial patient and client bookings may need to be limited in order to ensure that patients/clients can follow physical distancing recommendations while accessing services, but should be prioritized by urgency.

Elective procedures for confirmed COVID-19 patients and those patients who have had contact with, or exposure to, a COVID-19 patient (known and being followed by public health officials) should be delayed until the patient is deemed recovered and non-infectious according to the provincial protocols, or the procedure becomes urgent or emergent.

Before coming to the clinic:

  • Clinic staff should contact patients/clients by phone to determine if patients/clients or family members have developed COVID-19 like symptoms, have COVID-19 contact and/or have recent travel history.  Please refer to Screening Scripts for Ambulatory Setting (on page 5).
  • Standardized pre-screening documentation is available in Cerner with corresponding paper documentation available in SoftMed (SCM).
    • If screening identifies that the patient has COVID-19 –like symptoms, the Clinic team should determine:
      • if the patient needs to be referred for testing, and
      • whether the patient still needs to be seen in person, if a virtual visit is possible or if the visit should be rescheduled to a later date.
  • Patients/clients should be reminded to notify staff of any changes in their health prior to coming to clinic.
    • Action: Ensure that patients have clinic contact number to notify.
  • Patients/clients should be reminded that they will undergo screening assessment at several points (e.g.: phone pre-booking, at the entrance of the facility, at the clinic level)
  • Patients/clients should be notified that all appointments/procedures are subject to the discretion of the Most Responsible Provider and may be cancelled or rescheduled at any point.
What should patients/ clients expect when they arrive?
Continuing controlled access with specific entry points for public access and staff with security and/or volunteers.

At the entrance of the facility, greeters/volunteers will conduct screening.  Please refer to page 8 of this document for a screening script.

At arrival, patients/clients should perform hand hygiene.

  • Action: Ensure patients/clients remove gloves, if applicable, and perform hand hygiene. Gloves should not be put back on.

Patients/clients with visible and self-declared COVID-19-like symptoms will be required to wear a surgical/procedure mask provided by the health authority.

Other considerations: If the site has physical distancing constraints, the use of masks for all patients and clients, regardless of COVID-19 status may be considered.

If the patient/client is not symptomatic, they can wear their own masks during their visit.

  • Action: ensure directions are accessible to avoid wandering while travelling to destination.

Screening at destination

At arrival, patients/clients should perform hand hygiene.

As part of the check-in process, look to see if there is current evidence of screening.  If there is no screening within the last 72 hours, the patient/client will be asked screening questions. Please refer to page 9 of this document.

COVID-19-like symptomatic patients require droplet and contact precautions.   Each area should, if possible,  identify a designated examination/isolation room and or waiting area for placement of patients presenting with COVID-19 symptoms where patients can be placed directly upon arrival. 

Alternative solutions to waiting in the common areas should be considered.  These solutions may include text messaging and/or decanting to larger gathering areas while waiting to be seen.

During clinic stay

Follow the Point of Care Risk Assessment to determine appropriate PPE requirements. 

Throughout the visit, remind patients/clients to:

  • practice respiratory etiquette, such as coughing and sneezing into the elbow, avoiding touching the face, mouth, nose, eyes and, if applicable, mask
  • perform hand hygiene.
  • maintain physical distancing.

After clinic visit

Patients/clients should perform hand hygiene before leaving the clinic and the facility/building. 

Can patients/ client bring visitors?
To reduce risks of COVID-19 for patients, clients, family and staff, no visitors are permitted for Ambulatory appointments.

If the patient/client requires support to attend, this is to be restricted to one person.  They should be asked to bring their own mask if possible. 

Support persons who present with COVID-19 like visible symptoms should not be permitted to enter the facility for the safety of patients and staff.

INFECTION CONTROL KEY PRINCIPLES AND CONSIDERATIONS - PERSONNEL / STAFF / MEDICAL STAFF

What is the process for Staff/medical staff?
All Staff/Medical Staff
  • Staff/Medical staff must follow the PPE Recommendations – Acute
  • Staff/Medical staff should be encouraged to clean and disinfect their own work space following the IPAC Guidelines.
  • Each clinic should identify a dedicated room for direct placement of high risk/COVID-like symptomatic patients and waiting areas.
  • If a patient with COVID-19-like symptoms must be seen in the clinic, Staff/Medical staff should place the appointment at the end of the day if possible.
    • If not possible, then the patient should be seen in the dedicated room for direct placement of high risk/COVID-19-like symptomatic patients.
    • If there is a significant concern that the patient is high risk for COVID-19, and there was evidence of gross contamination of the environment by the patient (for example unrestricted coughing and sneezing), the examination room should be closed until terminal clean can be performed.
    • If the examination room cannot be closed, Staff/Medical Staff should clean and disinfect high touch surfaces using appropriate disinfectant wipes, following the PHC Guidelines for Cleaning and Disinfection of Equipment/Devices/Surfaces
  • For patients with no COVID-19-like symptoms, Staff/Medical Staff should follow routine department practices for cleaning and disinfection between patients.
  • Team meetings and in-person interactions should be replaced with virtual options, as much as possible.  If not possible, maintain physical distance.
  • Staff/Medical staff must avoid sharing food and snacks. 

 

Should staff be changing their clothes when they enter/exit the hospital? Where can they get changed?

We know that it can be challenging to follow the protocols about what to wear and where to change, especially in our older buildings. We appreciate your efforts to follow these guidelines.

At the start of your shift:

  • Wear street clothes and shoes to work.
  • Change into your uniform (scrubs) and work shoes after you arrive.
  • Store your clothes in the staff room or near where you keep your lunch.
  • Refrain from going out of the hospital during your shift.

At the end of your shift:

  • Change back into your street clothes.
  • Place your uniform in a plastic bag and bring home with you; leave your work shoes at work.
  • When you get home, wash your uniform in hot water.
  • Take a shower.

We are working with environmental services to ensure the areas where we can change are cleaned regularly.

During the Covid-19 pandemic, Providence Health Care will provide hospital laundered scrubs to staff and physicians working in Covid-19 dedicated units.

Click here to read more about hospital laundered scrubs.

INFECTION CONTROL KEY PRINCIPLES AND CONSIDERATIONS - EQUIPMENT / SUPPLIES / ENVIRONMENT

What is the protocol for elevators and stairwells as restrictions ease?
Physical distancing is encouraged in elevators.

An elevator monitor will be available to assist and direct accordingly.  Masks can permit increased elevator occupancy.

  • Action: Place posters to remind of elevator etiquette, physical distancing and place floor layout in the queue line and inside the elevators to guide users.

Seating in staff shared spaces, waiting rooms, cafeterias, coffee shops and common areas (lounges) should be spaced/taped off to maintain two meters separation.

What is the protocol for cleaning and disinfecting clinical, administrative and public areas as restrictions ease?
Cleaning Public Areas
  • Public areas, such as hallways and stairways, should be cleaned and disinfected on a daily basis and when needed.

Cleaning Clinical Areas

  • During the examination, any medical/clinic equipment used (e.g. blood pressure cuffs, clipboard) should be cleaned and disinfected by the user following the routine department practices for cleaning and disinfecting.
    • When possible, single use equipment and supplies are recommended.  
  • Common areas and high-touch surface areas should be cleaned and disinfected regularly BY THE USERS OF THE AREA, with a focus on high touch points such as reception counters, seating areas (including clinic room seats and armrests), light switches, door handles, toilets, taps, handrails, phones, keyboards, and counter tops.
  • For cleaning instructions, disinfecting and frequency of equipment, refer to the Infection Prevention and Control Master Equipment Cleaning and Disinfection Manual.

Cleaning Non-Clinical Areas

  • Other areas such as lunch rooms, lounges, and offices on the unit should be decluttered, cleaned and disinfected on a daily basis and as needed by those using the space.

Cleaning Administrative Offices

  • High touch surfaces in administrative offices should be decluttered, cleaned and disinfected on a daily basis and when needed by the user of the space.
What, if any, changes are there to layout and flow?
Hand hygiene stations should be available at all doorway entrances and exits and be easily accessible.
  • Action: Ensure appropriate hand hygiene supplies are in place and hand hygiene products are maintained

Seating in staff shared spaces, waiting rooms, cafeterias, coffee shops and common areas (lounges) should be spaced/taped off to maintain two meters separation.

  • If staff lounges are not large enough to accommodate spatial separation, consider staggered breaks or alternate break areas.

Non-essential items (remote control, magazines, brochures, etc.) should be removed from waiting and gathering areas.

Alternative solutions for the waiting room should be considered.  These solutions may include text messaging and/or decanting to larger gathering areas while waiting to be seen.

Reception area and clinic hallways should have visual cues to assist in physical distancing (two meters) and, if possible, one way directional flow.

Requests for Plexiglas will be reviewed on a case by case basis, but will only be considered where work flows would not require extended use PPE.

SCREENING

What type of screening will be done at the door for outpatients coming into the hospital and how can we ensure it is consistent between greeters?
We are following the regional guidelines and the provincial guidelines around screening and testing. All of our ambulatory surgical patients are being pre-screened before they come in. In some cases physicians are ordering testing. When patients do come into the hospital, they're going to be rescreened. We’re not rescreening at the door. What we're asking our greeters to do is to ensure there's good hand hygiene when patients come in and that they know where they're going. Then they'll be rescreened in the area they're getting treatment. We do have a script for your greeters and will make sure it is consistent between individuals.
Are care providers/family accompanying patients going to be screened for COVID-19? 
If the patient/client requires support to attend, this is to be restricted to one person. They should be asked to bring their own mask if possible. Support persons who present with COVID-19 like visible symptoms should not be permitted to enter the facility for the safety of patients and staff. 
Why are there different screening practices for LTC and Rehab staff at HFH who share the same spaces, such as the cafeteria? 

Anyone who works on LTC will continue to be screened at the door prior to their shift as per the Medical Health Officer Order before they enter the Long Term Care Facility.  

All staff, whether in LTC or Rehab, are required to follow PHC/BCCDC guidelines for the workplace. That includes physical distancing, hand hygiene, appropriate use of PPE, and not coming to work if symptomatic. Staff who are symptomatic should get tested as per public health recommendations.

WORKING REMOTELY

I have heard people suggest that as we move into phase 2, those that can work from home should continue to do so. This may help keep ridership down on transit, for example, to make sure it is available for people who really must use it to get to work. What are your thoughts on this for PHC staff? 

The short answer is absolutely. We're following the provincial government’s advice, and that is that you should absolutely continue to work at home, if you can work at home. That's what we have been doing, and some teams have made pragmatic decisions about needing to be at work some days but not on other days. There's no big change on Tuesday around this.

Essentially, there are no changes. People have been at work that needed to be at work; if you're able to work from home, you continue to work from home. If your leader or you want to have a conversation about coming into work, then we're asking the leaders to contact Occupational Health & Safety to talk about plans to have people return.

How will work spaces be assessed to ensure they meet new guidelines. What about consolidated departments? i.e. HIM, health records/registration in sites across other health authorities? 

With people working at home, there have been some real changes because most of us don't have offices set up at home that meet the same needs as at work. Occupational Health & Safety can do virtual assessments if it’s required. If you have concerns around your workstation, then give OH&S a call and they will take care of that assessment.

One of the most common things we hear from people working at home is that they forget to get up. They are sitting down for too long. We will send out reminders about making sure you get up and stretch, setting the expectations for the day.

When people are coming back into the workplace, they need to give OH&S a call and we will look at what spacing is required. We do want to maintain that physical distance that's required to ensure we're not spreading any viruses. We'll look at each set of circumstances to ensure we have that and that we have hand sanitizing stations. If there's not an ability to maintain that physical distance, we will provide masks to be worn for those circumstances.

Is the organization going to be providing ergonomics for those of us working from home, like a mini desk and computer screens?
We have not gone to that level of actually providing equipment to work at home. It would depend on the particular circumstances. Each circumstance would need a conversation.
Can staff continue to work from home if they don't have childcare and need to continue to home school? 

Staff who have been successfully working from home should continue to do so unless your work requires you to be onsite. We’re following the provincial government’s advice, and we are not asking for staff to return to the office; however, some teams have made pragmatic decisions about needing to be at work on some days, but not other days.

For staff who wish to return to the office, please speak with your leader/manager so arrangements can be made in conjunction with Occupational Health & Safety.

Will there be any support to supply dedicated work phones or reimbursement for long distance calls for those working from home and using telehealth for outpatient clinics?
A memo will be forthcoming outlining the process and rules for reimbursement of eligible work from home expenses.

GENERAL PUBLIC HEALTH GUIDELINES FOR WORKPLACE - INCLUDING PHYSICAL DISTANCING

Elevators are problematic for social distancing, but so are stairwells. Are we considering one way stairwells? Can you consider reopening more of the stairwells to reduce congestion? 
This is a high-priority conversation and the details are still being finalized. We will provide an answer soon.
With the increased traffic in the stairwell, will it be cleaned more than once per week? 
PHC has enhanced its cleaning services during this time with additional cleaning in public areas including doors/handles, stairwells and hallways.
Are there measures in place to help maintain safe social distancing in the office? 

Physical distancing within office space will be reinforced wherever possible by signage. Frequent handwashing will be reinforced as will disinfecting of hard surfaces.

While some property managers strongly encourage anyone walking through building lobbies or common areas to wear a mask, the advice at this point from Dr. Henry is that as long as you can follow physical distancing recommendations (including in the elevator), wash your hands frequently and stay home when you are sick, you should not need to wear a mask for the short period you may be in a lobby or common area.

If you feel you are unable to follow physical distancing recommendations, please contact OH&S. In circumstances where there is not an ability to maintain that physical distance, we will provide masks.

How many people are allowed in an elevator? Does the number change if they’re wearing PPE?
A higher occupancy of people is allowed in an elevator if everyone inside is wearing a mask. If not wearing masks, only 2 people are allowed inside and appropriate physical distancing measures must be followed.
When should staff consider using the stairs over taking the elevator?
To help reduce elevator queues and maintain physical distancing, we encourage staff to take the stairs as frequently as possible and allow priority elevator boarding for patients.
What entrances should staff use?
To help separate the flows of staff and public entering the hospital, we ask staff to use ONLY these four entrances:
  • The Code Orange entrance into the Providence Building (from inside the building, this entrance is located at the end of the hall between Cardiac Echo and Cardiac Ultrasound).
  • The back alley entrance into the Providence Main Building (between Medical Device Reprocessing and Physical Plant).
  • P1 Providence Building entrance (shared staff/public entrance).
  • Stairwell 16, accessed from the Courtyard via Thurlow Street (from inside the building, this entrance is located opposite the main Burrard entrance).

EQUIPMENT, SUPPLIES & ENVIRONMENT

What are the plans for staff protection at outpatient registration desks? Will sneeze guards be provided as in all retail operations? If not, then what are the barriers to implementing this measure? Aren't physical barriers better than worn PPE? 
We've had requests from many areas for Plexiglas and we’ve gone out and looked at the workflows for the people who are working in those areas. We determined that even if we put Plexiglas up, only a portion of those people’s days would actually allow them to avail of that protection. They still have to get up from their desk, they're moving around, and in those circumstances they need to have the right PPE on. Because we're going to extend the use of PPE, we're asking them to wear a mask and to wear eye protection, and those will carry with them. They move about the organization as the individual moves. That's far more effective than a stable piece of Plexiglass. From a principle perspective, we think that is the best way to protect the people working here. There may be other circumstances where it is the right thing to do (in long-term care, they would really like residents to be face-to-face at meal time and so that might be a better use of Plexiglas), but from all of the circumstances we've seen, we think that PPE is the best way to keep our people safe.
Are non-clinical staff able to get masks and gloves when asked to return to work?
For non-clinical staff, if PPE is required, it will be provided.
Have all the PPE donations been used? Gloves in particular. Are more needed? 

All PPE, whether donated or purchased from alternative vendors, must be put through a comprehensive testing protocol to ensure we don't use anything that is below standard. The donated PPE has been moved to a central PHSA warehouse where it can be held and used according to those guidelines. The donated PPE has not all been used yet. It is being assessed, categorized and stored and could be something that's accessed in the future.

We have sufficient PPE for the moment. We're really grateful for everything, but if people have small amounts of PPE they wish to donate, there are other industries, other businesses and small non-profits that would likely benefit from support and offers like that.

What about using face masks in indoor public spaces?

In indoor spaces where you're unable to maintain a physical distance, the personal protective equipment that we recommend for clinical staff is what you should be using. For example, in clinical areas where patient care is being provided. We have the prolonged PPE use policy which addresses this idea of inability to maintain physical distancing during the course of a work day. This should also be followed in areas such as lunchrooms and break rooms. Of course, while you're eating you can't have a face mask on so we have general guidance for these areas to stagger the number of staff.

For public spaces and indoor spaces, the Public Health Agency of Canada is recommending everyone use non-medical face coverings when they are unable to follow physical distancing recommendations. 

Is Providence purchasing more isolation gowns? These are often running out lately. And what about PPE supplies in general?

We do not have a shortage of isolation gowns at Providence currently, but individual units may need to increase their on-hand supply. If you are not able to get one on your unit, please let your manager know.

We have been working hard on several fronts to increase supplies of disposable gowns. There are large quantities of those items being purchased, and we are also working with local companies to bring in more reusable/washable gowns. Those are currently being manufactured for us right now. In addition, we have an order for gowns on their way over to us right now.

With regards to overall PPE, we have a lot of products now moving. We have large quantities in hand, plus a lot more in the pipeline.

The one exception is a certain model of 3M mask that has been affected by US restrictions. But even with that item, we have about 50-60 days’ supply provincially.

We are in a good place with our supplies of PPE. This has been achieved by applying several techniques, including fit testing for other masks, using reusable masks, and also being very clear about the proper use of PPE.

Can you clarify if eye protection/safety goggles/glasses need to be worn over the eyes on the clinical unit when not providing direct patient care? For example, while in a nursing station where everyone is wearing surgical masks? 

If you’re, say, a unit clerk and do not have any direct patient care, you do want to have your mask on. But if everyone around you also has their mask on, then you don’t need eye protection because you are not at risk of being in the line of their droplets. The reason why nursing staff continue to wear eye protection at the station is because we're asking them to keep it on for extended use and not take it on and off between patients. They need it when they're at the bedside, they don’t necessarily need it when they're at the nursing station, but because they contaminate their hands every time they touch it, we're asking them to leave it on. In short, you don't need to wear eye protection in your clinical area if you're not having direct patient contact and everyone around you has a mask on.

The other piece is around transmission and acquisition. We don't know how significant the transmission risk is through the lacrimal duct down to the sinus tract and into the upper respiratory tract. There have been concerns the virus may cause different presentations involving the eye including conjunctivitis, but we don't have enough evidence. In terms of bare levels of protection, protecting the respiratory tract is the primary one. Eye protection is also dependent on the type of protection that's available. Ultimately it comes down to a balance between comfort and the risk of acquisition, depending on the context in which you're providing care.

If no one in the ward has COVID, is there any PPE that has to be worn? 
It doesn’t matter if there is no patient found to be COVID positive on a unit. Anyone who has to provide patient care needs to wear appropriate PPE. Anyone who can’t maintain a two-metre distance from others must wear a mask and eye protection. Please see the PPE Recommendation Guidelines for more information regarding your area.
How often are the PPE spotters coming to units? Is there a schedule? 
The PPE spotters attempt to visit every Red or Yellow unit at SPH and MSJ every 1-2 days, usually in the mornings (this includes MSJ HAU, ED and 3B; SPH ED, ICU, 9C/D, and Medicine. PPE Spotters have not been covering nights or weekends. .
Are there other elevators that staff can use that the public does not?
Not at this time. 
What stairwells should staff use?
Staff will use the same stairwells as the public. Etiquette for the stairwell will include the following:  wait on the landing  for people to pass. 
How do we keep waiting rooms, other clinical spaces and equipment safe for patients, clients, staff and medical staff? 
 

• Centralizing waiting areas, text messaging/calling patients or clients when they are able to be seen and other alternative solutions to waiting in the hospital or clinic areas.

 • Waiting areas will be set up to ensure physical distancing with high-touch areas cleaned frequently and a deeper cleaning once a day. 

• Non-essential items should be removed from waiting and gathering areas.

 • All equipment is cleaned and disinfected between uses and tagged with an “I am clean” label, which is removed before the equipment is used on a patient or client.

 • High touch points are also cleaned between use for equipment that is dedicated to an individual patient or client. 

• Equipment specific to an individual (e.g. stethoscopes, badges, mobile devices, etc.) should be cleaned and disinfected daily and immediately after contact with a patient/client or patient/client zone. 

 • Clean and contaminated equipment is also stored separately with a minimum spacing of two metres

 

Who is responsible for cleaning rooms in between patients?

During the examination, any medical/clinic equipment used (e.g. blood pressure cuffs, clipboard) should be cleaned and disinfected by the user following the routine department practices for cleaning and disinfecting.

When possible, single use equipment and supplies are recommended.  

Common areas and high-touch surface areas should be cleaned and disinfected regularly BY THE USERS OF THE AREA, with a focus on high touch points such as reception counters, seating areas (including clinic room seats and armrests), light switches, door handles, toilets, taps, handrails, phones, keyboards, and countertops.

Local Emergency Operation Centres (EOCs) in partnership with Public Health and Infection Prevention and Control are responsible for ensuring the appropriate frequency and type of cleaning takes place.

Will we be using disposable blood pressure cuffs?

Any medical/clinic equipment used (e.g. blood pressure cuffs, clipboard) should be cleaned and disinfected by the user following the routine department practices for cleaning and disinfecting.

When possible, single use equipment and supplies are recommended.  

Will the hospital supply masks upon entry?
Yes. The hospital will now offer masks to all visitors and patients arriving at St. Paul’s.

VIRTUAL HEALTH

Why rush to return to in-person outpatient visits when virtual visits seem to be working well for most patients? 

Clinics do not have to bring patients back on site. If virtual visits are working well, please continue with that. For example, the Diabetes Center will continue to do most of their appointments virtually. On the other hand, patients in Geriatrics still don’t have a lot of access to technology and have communications issues. For those patients, we are slowly bringing them back in and seeing them as needed.

We have also heard from many patients from around the province who are finding it much better to be able to access their appointments virtually.

We should continue with this approach, bringing in patients face to face when necessary, for example in cases where a hands-on assessment is warranted, or there are issues with technology. But the default should be to continue with virtual visits whenever possible.

When we survey clinicians re: virtual health, will be able to drill down to get additional information (e.g., by type of visits - assessment versus therapy, by profession, etc.)? 
We have had an excellent response rate to the virtual health survey so far and hope to capture this type of information as we go forward.

REOPENING PLANS

Can you please summarize the surgical reopening plan at PHC over the next few months? 

The surgical team has been working on a very detailed plan, which actually started at the beginning of the pandemic and has continued throughout to ensure urgent and emergent patients received the proper care. Now we will be addressing the waitlist. There is a very purposeful plan around which patients will be seen next, between those on the waitlist and those who have become more acute during this time.

We are phoning the patients whom the surgical team have deemed will be next. They are pre-screened to ensure they are not symptomatic. If there are any concerns, patients will be tested before coming in. Then they will be screened again right before the surgery actually takes place.

The surgical team will also have a safety huddle before every surgical procedure to determine appropriate PPE and to ensure that everyone is aware of any potential risks. We will be limiting the number of surgeries the first week because we do want to ensure we have all of our plans in place, given the new guidelines around physical distancing. From there, we will ramp up our patients’ numbers each week.

These plans are specific to St. Paul's and MSJ because each site is unique. All the teams have had to come up with creative ways of ensuring safety and how to bring patients back in. It will be relatively slow to start, but we will consistently increase volumes to try and reduce the waitlist in a timely fashion.

We will be looking at resource utilization very carefully. As we increase surgical procedures, we will be monitoring the usage of PPE and adjust as necessary. For ICU bed utilizations, we do not have large ICUs so we will be ensuring beds are used properly, moving people as appropriate. We continue to have many non-surgical, non-COVID patients to care for so this may take some work if one site gets full.

The surgical program is also looking at ways to expand hours to evenings and weekends, while still maintaining distance between surgeries so cleaning protocols can be followed properly. Some physicians and staff have already told us they are not planning to take vacations and are willing to work extra shifts.

What about non-essential hospital visits for research participants? 

UBC is starting to phase in research activities. We are expecting an update next week for the gradual return of research activity. We will be following these guidelines at Providence as well.

Currently, there are 35 research projects active at Providence exempted from the shutdown. Many of these projects are related to COVID or to ensure essential laboratory assets are maintained. There are also some clinical trials that are starting to come back online. These do not require direct patient contact.

FAMILY & VISITORS

I have been visiting my parents through the window the last few weeks. Is it now safe to see my parents, who are seniors who have health conditions, in person while maintaining the 6-ft rule? I’m still leery since the virus is still active. But then again the numbers of infections/deaths have decreased. 
Public Health has some general parameters around visiting and increasing the number of people you socialize and interact with. Of course, some of those factors will depend on the risk of who you're interacting with. We know that, at minimum, patients might be infectious at least 48 hours prior to manifesting symptoms and that's why the contact tracing minimum goes back to 48 hours prior to symptom manifestation. So that risk will still be there. We know that the virus is still circulating and so you're never going to be in a situation where there's zero risk. We still need to avoid having large gatherings, where multiple people then have to assess individual risks. But if it’s a one-on-one interaction, depending on the situation, you can make that risk assessment based on your symptoms at the time, knowing that there is still potential to transmit while asymptomatic.
Does the site have any COVID patients?
Since the outbreak was declared, SPH has admitted and cared for 29 COVID-19 positive patients, and MSJ has cared for 9. Currently, MSJ has no COVID-19 patients and SPH has two, but those numbers will fluctuate and change.
Who can visit?
Visitor restrictions remain the same at our LTC facilities.  For acute care, visitors are restricted to essential visits only, as follows:
  • Visits for compassionate care (e.g., end of life and critical illness). 
  • Visits considered paramount to patient/client care and well-being, such as assistance with feeding or mobility. 

MATERNITY:

  • Maternity In-Patient: is allowed ONE birthing partner only 
  • Maternity Out-Patient: is allowed ONE support person. When in doubt, please call the unit. 
  • Neonatal ICU: is allowed TWO adult caregivers/support people

SURGICAL DAY CARE: 

  • One visitor can accompany a patient coming in for surgical day care. 
  • Visitors/family will not be permitted to remain in the hospital during surgery.  Surgical day care staff will call family to arrange for pick up after procedure or surgery.

OUTPATIENT CLINICS APPOINTMENTS:

  • Patients going to outpatient clinics are allowed ONE escort. 
What entrance can visitors use?
At St. Paul’s, visitors and outpatients are only allowed to enter the Burrard or Thurlow Street entrances.  At MSJ, visitors and patients are being asked to use the main entrance only (off St. Edward St.). 
What kind of PPE protocols must visitors adhere to?
Upon entering any facility, visitors and patients must adhere to proper hand hygiene protocols.  That includes washing their hands with a hand sanitizer.  They will also be offered a mask to wear as they navigate the hospital.  Visitors with cold/flu symptoms will not be allowed to visit.  Patients with cold/ flu symptoms will be asked to wear a mask and report their symptoms when they arrive at their appointment.
What kind of hand hygiene protocols must visitors adhere to?
Upon entering any facility, visitors and patients must adhere to proper hand hygiene protocols.  That includes washing their hands with a hand sanitizer.  They will also be offered a mask to wear as they navigate the hospital.  Visitors with cold/flu symptoms will not be allowed to visit.  Patients with cold/ flu symptoms will be asked to wear a mask and report their symptoms when they arrive at their appointment.
Are there any limitations on what can be brought in to patients? (Food, gifts)
The only gifts that can be brought in for a patients is as follows:
  • Non-perishable food and only enough for one meal – left-over food requiring refrigeration will be discarded. 
  • Food must be fully wrapped.
  • Dishes and cutlery will not be retained.
  • Items/packages should not be too large.

Gifts/ items we are not accepting:

  • Pets 
  • House plants and flowers
  • Easily breakable items which could leave sharp edges, such as those made of glass
Am I allowed to accompany my family members to their outpatient visit?
Patients going to outpatient appointments are allowed one escort. One visitor can accompany a patient coming in for surgical day care.  Visitors/family will not be permitted to remain in the hospital during surgery.  Surgical day care staff will call family to arrange for pick up after procedure or surgery.
What entrance should outpatients use?
At St. Paul’s, visitors and outpatients are only allowed to enter through the Burrard or Thurlow Street entrances.  At MSJ, visitors and patients are being asked to use the main entrance only (off St. Edward St.). 
Where can visitors park?
St. Paul’s Hospital has an underground parking lot, as well as a small open-air lot off Thurlow and Comox streets. Please note that these lots are often full. Disabled parking places are reserved in the underground parking lot near each bank of elevators. In addition, there are several parking lots within walking distance of the hospital. For more information on parking, click here.

MSJ has a parking lot onsite off Kingsway. For more information, click here.

STAFF PARKING / TRANSIT

What are the plans for staff parking now that more patients and visitors are expected to come? Parking at Century Plaza Hotel gets filled up very quickly. If more staff have to resort back to transit, how would this affect their risk of potentially getting COVID? 
We are waiting for some guidance from the province. The province is looking at the situation; it declared that parking be made free. The province is aware it needs to make some changes to allow patients to come back. We're working closely with the province and our counterparts to make sure we have a consistent approach. We are also working with the local hotels to ensure we get the maximum amount of hotel parking available for our staff. There is also street parking still available. The city is continuing to try to support us on that. 
What about parking? Parking for staff is a challenge.

This week we have started to take back some of the parking for staff to designate for patients. You will start to notice more areas roped off for patients and our parking ambassadors actively helping patients find spaces.

Next week, we will be allocating more spaces to patients. Also, we are starting to see the free parking in the neighbourhood returning to normal. The free City of Vancouver parking spaces for health care workers, with very strict criteria for eligibility, will be available until May 31. After that, regular pay parking will resume. Hotels in the area are starting to see a return of their own clientele, so they will be returning to paid parking.

Regarding the Century Plaza, they generously offered us 80 parking spaces. We have actually been using 135 of their spaces as no one else has been using those stalls. But starting Tuesday, May 19, this will be changing.

We know transportation is going to continue to be a challenge for our staff. We are trying to acquire more dedicated parking spaces, but these will likely be paid spots. Updates will be provided in the staff COVID bulletin so please check that for the latest information.

ADDITIONAL QUESTIONS

What is happening with the CST project? 
We're very committed to continuing with the CST project. It obviously took a pause during the pandemic. Grant McCullough and his team have gone out to all the programs to ascertain what still needs to be done to sustain what we went live with last year, and what still needs to be implemented. We have a very comprehensive list of what's left to do and what's still needed from a sustainment perspective.
Will lessons learned from this event be incorporated into the design of the NSP? 

Yes, absolutely. Currently, the design of the new St. Paul’s is being re-looked at with COVID in mind. The good news is that it was already designed thinking about pandemics and many of the obvious things we struggle with (lack of single rooms, lack of negative pressure, more space) are automatically in there.

That applies not just to the new St. Paul’s, but also our initial views around MSJ and also long-term care and ensuring that our long-term care residents each have their own room and bathroom.

The designs are reasonably far advanced for the new St. Paul’s; however, there will be an opportunity to review them. We will reflect on what we've learned and we can feed those learnings into all of our physical designs.

Will PHC be issuing a Form T2200, Declaration of Conditions of Employment for taxation purposes for a home office?
An update on the requirements for issuing a T2200 is forthcoming.

 

This page last updated May 28, 2020 4:07pm PDT