April 29: Town Hall Q&As

If you missed the Wednesday, April 29 PHC All-Staff Town Hall, here are the Q&As which includes answers to the questions which were addressed during the session. 

Personal Protective Equipment

Currently, do we have enough PPE?  What happens if we get another wave of infections in the fall and winter season — are we prepared?

Providence has done a really good job of appropriately using PPE  and this has been highlighted in our inventory of PPEs and reviews. The initial response to the need for PPE was massive and was comprehensive throughout the province.

There is now a partnership with PHSA, which does all of the centralized procurement, and there are new trade contacts and routes set up in place. We are working with established manufactures, such as 3M, to ensure that we are getting a weekly allocation of masks. There is also a formula that helps ensure sites that need PPE to deal with COVID-19 are getting them.

When we return to our regular capacity and workflows, how will PHC educate patients and staff that aren't used to PPE and hand hygiene?

To ensure all PHC staff are well educated, we will need to identify those staff who are not yet familiar with PPE and hand hygiene protocols. The expectation is that this should be done at the unit level with the support of unit level leadership. The unit leadership and staff will need to identify what deficiencies exist and find the appropriate education through IPAC.

Baseline education is currently provided during staff orientation.

A new addition to our PPE and hand hygiene strategy is the inclusion of spotters on the wards. Spotters are there to help identify areas of improvement with staff and provide feedback in real time. 

 
With the extended use of PPE, the ask has been that we use the same mask and/or face shield when we move from symptomatic to asymptomatic patients — is this safe? Also, why are some staff not wearing masks when they are in the wards? 

According to infection control principles, this is safe as long as they maintain the physical distancing measures of two metres.

For health care workers who are providing direct care throughout the course of the day, we ask that you wear surgical mask because you will be moving from patient to patient. In addition, interacting with other colleagues directly on the unit. 

How about keeping distance from other colleagues? Can we wear a mask if we can’t keep two metres from other staff?  And will clear masks be available for those working with hearing impaired patients who need to lip read?

As per public health recommendations, in situations in which physical distancing of 2 metres cannot be maintained (such as tight hallways and elevators), staff are asked to follow recommendations on use of PPE.

These rules apply not just to clinical spaces, but also when you are on your breaks or in elevators. We need to remember this is not just about keeping our patients safe, it’s about keeping one another safe. If you cannot socially distance within your break room, you have to keep your mask on while you are in there, or find another place to go. We understand that is tough, but it’s for everyone’s safety.

Please click here for more information on appropriate donning and doffing of PPE

Clear masks are being explored as potential solutions for patients who are hearing impared and who lip read. We are looking at alternatives for face shields and other items that we can use to ensure our patients who need that assistance can receive it.

Hand Hygiene and Infection Prevention & Control 

Showering post AGMP events like code blue? What are the recommendations of when a shower is needed?
The option to shower is based on the code blue team protocols. Showering is also optional post AGMP.
I did N95 mask testing many years ago, where do I go to redo my fit testing? Who do I contact to discuss N95 mask fit testing?
Fit testing is coordinated through the Occupational Health & Safety (OH&S) department. During these extraordinary times, N95 Fit Testing is coordinated on a departmental/unit level. Please reach out to OH&S by emailing OHS@providencehealth.bc.ca.
In the fall & winter with cold, flu & covid circulating wouldn't it be best if everyone wore masks regardless of how they feel?
At this time, we are unable to predict whether we will use the current mask/eye protection policy for the cold and flu season.
Can you share a document that outlines our procedures for contact tracing in the event of an exposure, for both a patient or that of a staff member?
Please find the link to the information here.  This document was updated on April 15.  

Testing

Could you share a guideline on contact tracing?

This is available on COVID-19 website and will be shared again via this week’s e-bulletin. These are PHC documents. We don’t have access to public health documents for contact tracing within the community. our contact tracing hasn’t changed. This is a process that has been in place for a long time. It may have ramped up in terms of numbers, but this is a well-established piece of work we have been doing for a long time.

Click here to read the Contact Tracing Workflow

Why is coughing and sneezing associated with the NP swab procedure not considered an aerosolized generating procedure?

Some of you may have read that during normal routine coughing and sneezing, aerosols will be generated. What we do know with COVID, as with other respiratory viruses that do generate aerosols, the generation of aerosols itself does not equal to transmission of infection. From the epidemiology and observation of what occurs during large outbreaks, as well as observation from exposure events, the acquisition of an NP swab has not been attributed to transmission of infection. That’s why we use droplet and contact protection when we take NP swabs. It may be confusing when you read in the literature of nasopharyngeal aspirates, but that is a different procedure.

Click here to watch the video.

Why are those with mild symptoms not being tested? It’s allergy season and some might not recognize that they have COVID. 

The provincial guidelines are clear now and anyone can get tested if anyone has symptoms. The guidelines were updated April 23. The criteria was changed by public health because of the current prevalence of COVID in the community, as well as the different phase we are in now in the outbreak. The testing guidelines make it very clear that any physician who has clinical suspicion can order the test. If they do not routinely perform the test, there are 80 sites across the province where people can go to get tested.

For more information on the most recent testing guidelines in British Columbia, click here.

COVID-19 Planning & Activities

Will we have a one-week warning when public health detects a surge, before these patients hit the hospital, and critical care? What capacity of flex do we need?
It’s hard to speculate not knowing the nature and scope of when a “surge” could occur. However, the provincial readiness planning over the last 6 weeks has prepared us in the event of a surge. The program changes we all instituted are being analyzed to further refine plans for future pandemic events. There are detailed plans being drawn up in anticipation of a government directive and we will be following that directive in a careful, gradual, and measured approach. And we will try to balance this with the needs of our patients who need to be looked after for non-COVID reasons as well as the safety needs of everyone. 
Can you give us an idea about the expectations for a second wave of infections in terms of timing, monitoring, and plans for flow of patients through PHC sites?

We cannot predict the timing of a subsequent increase in cases.  We rely on public health surveillance systems to alert of clusters and increases in cases so that acute care and long-term care facilities can prepare.

What we do have is public health systems in place to inform us and provide advance warning if there is an increase of COVID-19 within the community. That will inform the practices and the interventions that need to be done within public health systems, as well as at our acute and long-term care sites and facilities.

We have been working with modeling data to help our planning for our initial surge wave, when will we have predictive models for the fall?
The modelling data comes from BCCDC and the Ministry of Health.  When updates are available, we will find them on the BCCDC website.
Can we make these town halls available via t-con as well for those not able to access a screen? Please keep doing these town halls. They are appreciated!
PHC’s Communications & Public Affairs and Media Services teams are looking into Teleconference options for future town halls. Thank you for the suggestion and feedback!
What are the impacts COVID-19 will have on CST work?

There is some planning taking place behind the scenes. As we work to increase our services and resume projects, that would include CST.

Grant McCullough is still leading CST with Dr. Charles Lo and they will be approaching the clinical programs and coming up with what’s next and what’s makes the most sense in light of COVID-19.

What about families who can’t spend time with loved ones? 

Updated: We understand isolation is a significant issue among our residents and tenants, particularly during this challenging period. We are continually working on creative ways for families to stay in touch with their loved ones safely. Examples include:

● Delivering cards, emails and care packages to residents.

● Using virtual platforms like Facetime and Skype to communicate.

● Encouraging families to stand outside and share visual messages.

Please contact the home directly for more details on how you can reach your loved one.

What is PHC doing to support our most vulnerable and/or homeless and drug-using communities? 

We continue to give the excellent care that we always do to our most vulnerable and homeless populations. Of course, with COVID and recent restrictions in the hospital, it has put more pressure on this population. We’re working closely in partnership with Vancouver communities. There have been many initiatives set up, both for non-COVID and COVID patients who live in the Downtown Eastside, including housing.

Our outreach teams have been continuing to work and provide services and programs to our most vulnerable populations and enhancing these programs with resources available through partnership with Vancouver Communities and other organizations.

Will entrances be opened up for staff to enter and exit (such as the main Burrard entrance at St Paul’s)?
The role of the screeners at the doors is to be able to provide screening for COVID-19 and ensure that hands are sanitized when they come into our facility. We moved to having staff only entrances to ensure that screeners have the ability to be vigilant and to reduce the volumes of people at the public entrances.   At St. Paul’s, there remain multiple points of entry to the site for staff, including: Code Orange door, lane door next to MDRD, the Parkade (P1 and P2), as well as access doors in the central SPH courtyard. We request that all staff continue to be vigilant in hand hygiene as they enter any PHC site. Please visit the COVID-19 website for more information.

People Planning

With reduced services and some regular work/projects that have halted for now, will you be looking at any staff reductions?
No staff reductions will occur due to reduced services or reduced work/projects as a result of COVID-19.
With the push to have staff work remotely, how will this shift into a new norm for work at PHC in areas where remote work is feasible?
Providence will, of course, follow public health instructions in terms of how to bring people safely together. We need to ask ourselves what are we learning during this time around flexibility? We will be reaching out to leaders to better understand how we can work remotely. We are currently working on a plan to bring us back, again, not to the same place, but to how we can work to get our work done together.  
Can we do something about the rising anti-Asian racism and graffiti on the east side entrance of Thurlow Street?
This is a very distressing side effect of what’s going on right now. Providence has always had a zero tolerance for bullying in the workplace and we have respect in the workplace training for all staff. This is an important reminder for all staff: if something is happening, you need to report it so that we can and will put in the support in place that is required for the individual and the unit, as well as any investigations that need to happen. We will not tolerate this within any of our facilities and sites.
What agreements are in place with other health authorities to assist and support Lower Mainland consolidated staff who are working outside of PHC core sites?
Providence is always talking to the leadership of our consolidated services around different practices at different health authorities. When they bring a concern forward that is different then what Providence has put in place, we reach out to the other health authority to discuss and ensure we can have agreements around practices to ensure our staff are safe.
How can we run meetings in a different way and can we use Zoom? 
PHC rolled out Zoom in a first wave, which was for clinical virtual visits, and we now have over 1000 accounts set up and provisioned across Providence. For non-clinical purposes and meetings Skype For Business is the recommended platform.
This page last updated May 28, 2020 5:17pm PDT