ICYMI: Deadline for Hospitals to Post Crisis Care Continuum Guidelines Is Jan. 6
The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-91, which addresses the need for all health facilities to have crisis care continuum Guidelines and to implement those guidelines if they are experiencing surge as a result of the current increase in COVID-19 cases. The AFL outlines new expectations for hospitals during the current surge and includes links to the CDPH Crisis Care Continuum Guidelines and its new Crisis Care Guidelines Pre-Implementation Checklist.
Notably, the AFL states that, by Jan. 6, all facilities must notify their local CDPH district office and local public health department via email that they have adopted and publicly posted (including a link to the posting) their own crisis care continuum Guidelines, another facility’s guidelines, or California’s Crisis Care Continuum Guidelines. According to the AFL, hospitals are expected to have plans that best fit their facility’s and regional needs and processes, while following ethical principles, health equity goals, and civil rights laws. Additionally, hospitals that need to implement crisis care, including triage of critical care resources, must notify their local public health department and local CDPH district office via email and phone call immediately.
Facilities that do not have current guidelines should consult with their Medical Health Operational Area Coordinators for technical assistance.
To assist hospitals during the winter surge, CHA has prepared several resources that highlight the guidelines’ key concepts and planning considerations for allocating scarce medical resources during surge operations. These include:
- A checklist for preparing for the possibility of moving to crisis standards of care
- A step-by-step guide for implementing crisis standards of care
- FAQs about crisis standards of care
- Key messages for use or customization with the media or public
CHA has also posted a recording of its webinar reviewing the Crisis Care Guidelines.
Revised Infection Control Survey Tool Includes Updated CDC Recommendations for Employee Screening
The Centers for Medicare & Medicaid Services (CMS) has issued a revised COVID-19 focused infection control survey tool for acute and continuing care providers. Among the revisions, CMS aligns the survey tool with recent updates from the Centers for Disease Control and Prevention (CDC) related to screening and triage of those entering health care facilities. Specifically, the survey tool assesses whether the facility has a screening process for all staff to complete prior to or at the beginning of their shift that reviews for exposure to others with known or suspected COVID-19, signs/symptoms of illness, and includes whether fever is present (screened upon arrival or self-reported absence of fever).
In accordance with QSO-20-35-All, related to the revised survey prioritization, surveyors will continue to use the COVID-19 infection control survey tool as part of any survey conducted during the public health emergency. The survey tool will generally not be used for investigations where a complaint allegation is not related to infection control concerns.
Data Reporting Updates Include ICU Surge Beds, Therapeutic Fields
With the surge in COVID-19 cases and the decreasing ICU capacity across California, the state finds it necessary to track ICU surge beds. To capture this data, CHA will update the CHA COVID-19 Tracking Tool to include a new field called ICU Surge Beds (a subset of the Total Surge Beds field) on Jan. 8. Following are updates to data reporting:
- The addition of one new field: ICU Surge Beds
- The four weekly therapeutic fields below will become mandatory on Wednesday, Jan. 13
- Current Inventory: casirivimab/indevimab
- Courses Used in Past Week: casirivimab/indevimab
- Current Inventory: bamlanivimab
- Courses Used in Past Week: bamlanivimab
- The U.S. Department of Health and Human Services recently provided clarifications on therapeutic reporting (see page 7 of this Q & A document). Courses used/administered should be counted for locations including an inpatient, ED, overflow, or outpatient location, such as an urgent care, infusion center, or outpatient clinics.
CHA will provide hospitals and systems currently using the data upload feature with a revised template in advance. The revised data dictionary includes updates highlighted in blue. In addition, CHA is working with CDPH to update the data reporting guidance document. Questions can be directed to COVIDTracker@calhospital.org.
CalVax to Replace COVIDReadi as Vaccine Provider Enrollment System
CDPH has announced a new vaccine management system, CalVax, which will launch on Jan. 11. CalVax will replace the existing COVIDReadi system and be a statewide centralized system for health care providers enrolled in the California COVID-19 Vaccination Program. CalVax allows providers to enroll in the California COVID-19 Vaccination Program, order vaccines, update account information, and manage vaccine reporting tasks. Providers enrolled in COVIDReadi, or that have completed part A of the COVIDReadi enrollment process and at least some of part B by Jan. 8, will not need to re-enroll in CalVax. CDPH will provide a demo of this new system during its Jan. 8 webinar, from 9 to 10:30 a.m. (PT), for providers (link to register here; details below).
CDPH Issues Guidance on Vaccine Distribution, Management
CDPH has issued a Vaccination Program update that includes details on redistribution of the Moderna vaccine, how to return vaccine shippers, how to minimize wasted doses, and information on the VaccineFinder tool. Key information is as follows:
- Redistributing the Moderna vaccine: What to do after a vial has been thawed, storing and distribution temperatures, and links to a guide to redistribution, repositioning and transfers; redistributing vaccines; guidance for satellite, temporary, and off-site clinics; and transporting the vaccine
- Vaccine shippers: The Pfizer thermal shipper and temperature monitoring device should be returned within 30 days of delivery. Return instructions are provided in the Shipping & Handling Guidelines brochure, which ships with vaccines.
- Minimizing waste:
- For the Pfizer vaccine, room temperature hold time is up to two hours prior to dilution, then use or discard after six hours.
- For the Moderna vaccine, room temperature hold time is up to 12 hours total (including prior to and after puncture). After puncture, use or discard within six hours.
- Preventive measures include counting eligible persons and doses in advance before thawing or removing from storage and creating standby lists of prioritized persons to use in case of unused doses.
- VaccineFinder: What to expect as a newly enrolled provider, what to do if provider registration is incomplete, inventory reporting requirements, links to fact sheets and training documentation, reporting responsibilities for providers that plan to use a hub-and-spoke model for vaccine distribution, and more.
CDPH has posted this and other California COVID-19 Vaccination Program Updates on the archived communications section of its COVID-19 Vaccination Program website.
Weekly DHCS Behavioral Health Provider Calls Start Jan. 6, 8 a.m. (PT)
The Department of Health Care Services will begin holding weekly calls for mental health and substance use disorder treatment facilities and providers every Wednesday at 8 a.m. (PT) beginning on Jan. 6. The calls will feature subject matter experts from CDPH and the California Department of Social Services, provide updates on emergency surge response, and answer questions about licensing and certification flexibilities, alternative sites, testing, vaccination, isolation and quarantine, and more. To join, go to the meeting webex site.
CMS, CDC to Host Jan. 6 Fireside Chat on Vaccine Safety for Nursing Home Staff, CNOs
CMS and the CDC will hold a fireside chat webinar for providers on vaccine safety Jan. 6 at 1 p.m. (PT), targeted for nursing home front-line staff and chief nursing officers. The second in a special series addressing staff questions and concerns, the webinar will focus on myths surrounding vaccine danger and include panelists from CMS and the CDC, as well as a certified nursing assistant. Questions for the panelists can be sent in advance to COVIDemail@example.com. Registration is available online; after registering, a confirmation email will be sent with details for joining the webinar.
CDPH Webinar for Providers on Vaccination Program Is Jan. 8
CDPH will host a webinar for hospitals and other providers with COVID-19 vaccination updates on Jan. 8 at 9 a.m. (PT). This webinar will include a demo of the new CalVax system. Visit this link to participate. Future webinars for providers are expected to continue weekly on Fridays from 9 to 10 a.m. (PT).
Data Resources During the Winter Surge
State Resources: Monitor the regional stay at home order and ICU capacity by region here. Monitor the ICU capacity by county here.
CHA Resources: Hospitals can access county dashboards through the CHA COVID Tracking Tool here, which includes hospital-specific data on ICU capacity.
FEMA Rule Continues Export Limitations on Certain PPE, Adds Syringes and Hypodermic Needles
On Dec. 31, 2020, the Federal Emergency Management Agency issued a temporary final rule that extends, through June 30, the designation that certain medical resources are limited to domestic use. The rule continues to apply to surgical masks, N-95 respirators, nitrile surgical and exam gloves, and level 3 and 4 surgical and surgical isolation gowns. The temporary final rule also adds specific syringes and hypodermic needles to the designated list. While the rule is in effect, subject to limited exceptions, no shipments of designated medical supplies may be exported from the United States.
Next CDPH Call for Health Care Facilities: Jan. 12, 8-9 a.m. (PT)
Dial: (844) 721-7239
Summary of Dec. 29 CDPH Call
CDPH has provided a summary of its recent weekly call with health care facilities.