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Emergency and Patient Intake

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Introduction

This tip sheet is for employers and workers involved with emergency and patient intake. This document provides an overview of recommended controls to help reduce the risk of exposure to COVID-19 in the workplace. Additional controls will also be required depending on the workplace and specific types of tasks performed by workers.

For general COVID-19 prevention practices, employers and workers can refer to the CCOHS COVID-19 Resources documents, including “Protect Yourself and Others”.

In all cases, guidance from local public health authorities and your jurisdictional health and safety regulator must be followed. Additional guidance is provided in the Government of Canada resource “Infection prevention and control for COVID-19: Interim guidance for acute healthcare settings”.

Consider the Risks

  • COVID-19 transmission occurs primarily when individuals are in close contact with an infected person. At close range, the virus may spread when large respiratory droplets fall through the air and land on mucous membranes of a person’s nose, mouth, or eyes, and through inhalation of smaller respiratory droplets or particles (often referred to as aerosols). The virus may also spread when individuals touch surfaces or objects that have the virus on them, and then touch their mouth, nose, or eyes before cleaning their hands.
  • The risk of contracting COVID-19 increases in situations where people are in closed spaces (with poor ventilation) and crowded places when with people from outside their immediate household. Risk is higher in settings where these factors overlap or involve activities such as close-range conversations, singing, shouting or heavy breathing (e.g., during exertion).
  • As an emergency and patient intake employee, potential sources of exposure include:
    • providing medical treatment to an individual who has COVID-19 (the risk would be greater when performing aerosol-generating medical procedures)
    • having close contact with another person who has COVID-19. (e.g., co-worker, Emergency Medical Services (EMS) worker, or person accompanying the patient during intake)
    • touching surfaces or items that have been touched or handled by a person with COVID-19, and then touching your mouth, nose, or eyes.
  • Each workplace is unique. Employers need to take every precaution reasonable to protect the health and safety of their workers. These precautions include assessing the risks of COVID-19 for their specific workplace and the activities conducted by their workers.
  • The employer must then implement appropriate hazard controls using the hierarchy of controls (i.e., elimination, substitution, engineering controls, administrative policies, and the use of personal protective equipment (PPE)). Use multiple personal preventive practices in a layered approach.
  • Implement a written workplace safety plan that identifies potential exposures to COVID-19 and the controls implemented to protect workers.
  • Employers should consider the following:
    • Where and when do workers interact with others at the workplace (e.g., co-workers, patients, EMS workers, visitors, etc.)?
    • How close are the interactions? The risk of transmission increases with close and frequent contact with a person infected with COVID-19.
    • How long are the interactions? Evidence indicates that person-to-person spread is more likely with prolonged contact.
    • How will workers be protected if they are providing medical treatment to a person suspected of having COVID-19?
    • What changes are need to the layout of the workplace to help implement precautions such as physical distancing?
    • Where are workers taking their breaks and eating meals? Can physical distancing be maintained?
    • Can barriers be installed where it is not possible to maintain physical distancing?
    • How often are surfaces and objects cleaned and disinfected?
    • Do workers have the knowledge they need to protect themselves and others from the spread of COVID-19?
    • Are you able to assess if a worker, patient, or visitor may have COVID-related symptoms, and rapidly take appropriate actions?
    • What is the best method to communicate updates to workers?
    • What is the visitor policy?
    • What will be done to promote the vaccine?
    • Do workers have all the required supplies to protect themselves (e.g., personal protective equipment, hand hygiene products, cleaning, and disinfectant products)?
    • What should workers do if patients or visitors cannot or do not wish to follow the COVID-19 precautions?

Vaccine

Communication and Training

  • Provide information and instruction to workers about the hazards of COVID-19 and what they need to do to protect themselves and others. Topics should include:
    • What COVID-19 is and the common symptoms
    • How the virus spreads
    • Screening and what to do if workers feel sick or may have been exposed
    • How to protect themselves and others by layering multiple hazard controls and personal preventive practices at once
    • How to properly wear, handle, and care for personal protective equipment
    • Safe use of cleaning and disinfection chemicals
    • How to stay informed about COVID-19 (using reputable sources)
    • New and updated work practices and policies
  • Encourage workers to report any COVID-19 concerns to their supervisor or employer. Workers can also report concerns to their health and safety committee or representative, or union if present.
  • Provide regular communications so that workers are informed of updates and have an opportunity to discuss their questions and concerns.
  • Review existing methods of communication to decide which methods (e.g., bulletin board, email, team meetings, text, phone calls) are the fastest and most reliable to inform emergency and patient intake staff about COVID-19 updates.
  • Post signs throughout the workplace, as a reminder about which precautions to follow (e.g., hand hygiene, physical distancing). Post signs on patient doors about what precautions health care workers need to follow (e.g., contact and droplet precautions).
  • Post signs for all patients and visitors entering the facility. Signs should communicate what precautions to follow and to remind patients and visitors to alert a healthcare worker immediately if they experience any symptoms. Post signs in different languages based on the population in the local community.
  • Post COVID-19 information for patients and visitors on the facility’s website.
  • Make sure that there is a communication policy with local Emergency Medical Services (EMS) personnel. EMS should notify the facility about any symptomatic patients before arrival. This communication helps to ensure that staff are informed, and the appropriate precautions are taken when the patient arrives.
  • Provide mental health support resources for all workers, including access to an employee assistance program (EAP) if available.

Screening

  • Actively screen all persons who enter the facility (health care workers, patients, visitors, contractors, etc.). Use a checklist, a web-based tool, or have a designated person ask direct questions.
  • Limit the number of access points to the facility. Have a separate entrance for health care workers.
  • Workers who have COVID-19 symptoms should return home immediately (preferably not by public transit) or stay home if already there. If they develop symptoms at work, they need to put on a medical mask, or if unavailable a well-constructed and well-fitting non-medical mask. They should also contact their health care provider and local public health authority.
  • Symptoms can vary from person to person and within different age groups.
  • Symptoms may take up to 14 days to appear after exposure to COVID-19. Some people have mild or no symptoms.
  • Older adults, people of any age with chronic medical conditions or who are immunocompromised, and those living with obesity are at risk for more severe disease and outcomes from COVID-19.
  • To support contact tracing efforts, record the names and contact information of all workers and other persons who enter the workplace, as required by your local public health authority. Make sure that privacy is protected, and that the information is stored securely. Contact information must be destroyed in a timely manner according to privacy laws.
  • If a worker tests positive for COVID-19 and the case is work-related, additional notifications may be required (e.g., the jurisdictional health and safety regulator and worker compensation board). Complete an incident report and begin an incident review.
  • If a visitor screens positive for COVID-19 they should not enter the facility. They should wear a medical mask and return home immediately (preferably not by public transit).
  • If readily available and feasible, consider implementing routine rapid testing as an additional active screening measure. Consider how you will manage the response to a rapid test result.

If a Patient Is Suspected of Having COVID-19

  • Provide the patient with a medical mask.
  • Place the patient in a designated assessment room with the door closed, if available. Alternatively, use a designated separate waiting area where a space of at least 2 metres between patients can be maintained.
  • Encourage any patient with signs and symptoms of an acute respiratory infection to cough in their elbow. Provide tissues, alcohol-based hand sanitizer, and a plastic lined waste container.
  • Measures should be taken to separate those who have screened positive for COVID-19 from those who have screened negative, so they don’t interact. As much as possible, create separate triage and/or waiting areas, washrooms, and designated routes of movement.

Reducing Potential Exposures

  • Health care workers should conduct a point of care risk assessment before any interaction with the patient. This review involves assessing the likelihood of exposing yourself and/or others to COVID-19 based on the patient, the task being completed, and the environment. The assessment determines what precautions are required to protect you as the health care worker (e.g., wearing a N95 respirator).
  • Create teams of health care workers (cohorts) who will work on the same shifts, if possible.
  • Determine if any workers can work remotely (e.g., roles that perform administrative functions). Provide ergonomic support and resources for workers setting up home offices.
  • Eliminate non-essential work travel for all workers.
  • Discourage unnecessary physical contact such as handshakes.
  • Avoid in-person meetings where possible. Use remote communications methods instead (e.g., teleconferencing, videoconferencing). When in-person meetings are required, use a large well-ventilated space, instruct participants to stay the greatest physical distance (at least 2 meters) apart, and wear non-medical masks.
  • Reduce the amount of paper documentation or other items being exchanged between workers and between workers and patients. Consider using digital or electronic methods to exchange documents. If this exchange can’t be avoided, wash or sanitize hands after handling items.
  • Use single-use disposable patient equipment where possible. Discard into a no-touch waste receptacle after use.
  • All reusable equipment and supplies (e.g., blood pressure cuff) should be dedicated to the use of the patient who is suspected or confirmed to have COVID-19. If reuse with other patients is necessary, the equipment and supplies should first be cleaned and disinfected (or sterilized).

Physical Distancing

  • Keep the greatest physical distance possible (at least 2 metres) from others at entrances and while in the facility (when closer contact is not required for provision of care).
  • Avoid non-essential in-person interactions and keep essential interactions as few and as brief as possible.
  • Make sure workers know how to protect themselves when they need to work within two metres of another person.
  • Space chairs apart at least 2 metres in waiting rooms, cafeterias, meeting rooms and employee break areas. Remove chairs if necessary.
  • Add highly visible markers to floors (at least 2 metres apart) to promote physical distancing in areas where people may line up (e.g., screening areas, cafeterias).
  • Review training programs and determine if any training can be conducted virtually. Identify which training is essential and can only be conducted in person (e.g., those with a practical component that is considered critical to the department’s operations). Consider:
    • Establishing a maximum number of participants
    • Having participants wear a well-fitted and well-constructed medical or non-medical mask
    • Having the training conducted in a large, well ventilated space
    • Having participants maintain the greatest distance possible (at least 2 metres) away from others.
  • Post capacity limits at entrances to shared employee areas (e.g., kitchens, washrooms, conference rooms).
  • Maintain physical distancing during breaks and meals. Since medical masks can be removed when eating or drinking, limit the number of people taking breaks at the same time. Arrange for breaks to occur in larger spaces or outdoors (weather permitting) and at staggered times.

Ventilation

  • Verify that the mechanical ventilation system(s) for the facility is operating properly.
  • Ensure that regular inspections and preventative maintenance for the ventilation system(s) is conducted according to manufacture’s instructions.
  • If possible, consult a ventilation specialist to determine whether any enhancements can be made to the ventilation system(s) (e.g., increasing the percentage of fresh air intake, increasing air exchange rates, and improving filtration).
  • For additional information on indoor ventilation, please refer to:

Physical Barriers

  • Install transparent physical barriers where possible (e.g., screening areas, triage, and reception areas).
  • The physical barrier should be made from a non-porous material such as plexiglass than can be easily cleaned and disinfected.
  • For additional information, please refer to the CCOHS resource “Physical Barriers”.

Personal Hygiene

  • Continue to follow standard medical infection control protocols, including handling and disposal of contaminated waste materials.
  • Encourage frequent and proper hand washing with soap and water, for at least 20 seconds. If soap and water aren't available, use a hand sanitizer containing at least 60% alcohol.
  • Place hand sanitizer in high traffic areas (e.g., facility entrances), at the entrance of each patient room, and at nursing stations.
  • Ask everyone who enters the facility to perform hand hygiene with hand sanitizer.
  • Follow the World Health Organization’s “My five moments for hand hygiene” approach to cleaning their hands:
              (1) before touching a patient
              (2) before any clean or aseptic procedure is performed
              (3) after exposure to body fluid
              (4) after touching a patient
              (5) after touching a patient’s surrounding
  • Also wash hands at the start of shift, before eating or drinking, after touching shared items, after using the washroom, after removing PPE, after cleaning and disinfecting objects, and at the end of the shift.
  • Discourage individuals from touching their eyes, nose, or mouth with unwashed hands and from touching the outer surface of their mask while wearing or handling it, as it may be contaminated. Promote hand washing or use of hand sanitizer after putting on, touching, or removing masks.
  • Promote good respiratory hygiene. Provide disposable tissues and remind individuals to cough or sneeze into the bend of your arm or a tissue and to dispose of tissues immediately, followed up with hand washing or use of hand sanitizer.
  • Verify that all necessary materials are readily available in the workplace (e.g., hand sanitizer, no-touch waste receptacles, disposable tissues).
  • Make sure there are designated handwashing sinks for health care workers.

Cleaning and Disinfection

  • Viruses can remain on objects for a few hours to days depending on the type of surface and environmental conditions.
  • While medical settings already follow strict cleaning and disinfection protocols, existing infection control programs should be expanded to include touch surfaces and objects throughout the workplace (e.g., break rooms).
  • Use hospital-grade disinfectants to destroy or inactivate viruses.   The disinfectant used should have a drug identification number (DIN), meaning that it has been approved for use in Canada.
  • Workers should be trained on the safe use of the cleaning and disinfecting products. Always follow the manufacturer’s instructions when using, handling, or storing the product. Review the product’s label, and (if applicable) safety data sheet to determine what precautions to follow.
  • Select PPE that will protect workers from both the hazard of COVID-19 and the hazard of potential chemical exposure from the cleaning and disinfectant products used.
  • All surfaces that may have had contact with a patient or materials that were contaminated during patient care must be thoroughly cleaned and disinfected such as tools and equipment (e.g., blood pressure cuffs, stethoscopes, etc.), bed, bathroom sink, toilet handles, waiting room area chairs, etc.
  • All surfaces or items that are touched by or in contact with health care workers (e.g., computer carts, medication carts, charting desks or tables, computer screens, telephones, touch screens, chair arms) should also be cleaned and disinfected.
  • When changing bed linens, they should be placed in a laundry container. Do not shake dirty laundry. Launder items according to the manufacturer’s instructions. Machine wash using the warmest appropriate water setting (preferably hot water), use laundry detergent, and dry thoroughly.
  • Change out of work clothing at the end of each shift and wash them (see laundry tips mentioned above) before wearing again for another shift. Do not store street clothes and work clothing in the same space unless both are clean.
  • Declutter the workplace to reduce the number of objects that need to be cleaned and disinfected.

Personal Protective Equipment (PPE)

  • Review and update procedures to include the PPE that will be used to protect workers from COVID-19. Follow any specific PPE requirements for your jurisdiction (if applicable) and work sector.
  • Medical masks should be worn by staff, visitors, and patients (where tolerated) upon entry to emergency and patient intake areas.
  • Wear items that are required for droplet and contact precautions (includes gloves, a long-sleeved gown, a medical mask, and eye protection), at minimum, when caring for patients who are suspected or confirmed to have COVID-19. Substitution of an N95 or equivalent respirator in place of a medical mask may occur based on a health care worker’s point-of-care risk assessment and/or if an aerosol generating medical procedure is being performed and/or local requirements.
  • Reusable respirators, including powered air purifying respirators (PAPRs), must be cleaned and disinfected according to the manufacturer’s instructions before re-use.
  • Ensure that workers are trained on the proper use of PPE including donning and doffing procedures. Make sure that workers understand the limitations of PPE.
  • Training on the care, use and storage of respirators should include:
    • Limitations of the respirator.
    • Inspection and maintenance of the respirator.
    • Proper fitting of the respirator.
    • Cleaning and disinfecting the respirator (if applicable).
  • Make sure that workers are fit tested before they are required to wear a tight-fitting respirator (e.g., N95). Fit testing verifies that there is an effective seal between the respirator and the worker's face.
  • Remind workers who may wear tight-fitting respirators, that they cannot have facial hair that comes between the sealing surface of the respirator facepiece and the face. Facial hair can cause respirators to leak around the face seal.
  • Make sure that there is written procedures regarding the selection, care and use of respirators.
  • Verify that appropriate supplies of PPE are available.
  • Ensure there is a safe area with disposal and decontamination supplies for workers to doff their PPE.
  • Develop procedures for the proper disposal of any single-use PPE. Waste should be bagged and deposited in an appropriate garbage container.
  • Ensure re-usable PPE is cleaned and disinfected after use according to manufacturer’s instructions. See cleaning and disinfecting section for additional information.
  • Staff doing pre-screening and registration should wear PPE (e.g., medical mask and eye protection).

Visitors and Caregivers

  • Entry and visitation policies and restrictions will vary depending on the degree of local transmission of COVID-19. Monitor COVID-19 activity in the facility and local community. Restrict access to visitors if necessary.
  • Create a visitor policy that:
    • Is adaptive and flexible to respond to local COVID-19 activity.
    • Reinforces the precautions required to be followed by visitors (e.g., screening, proper hand hygiene, wearing medical mask, respiratory etiquette, and physical distancing).
    • Is posted and shared with patients, visitors, and staff.
  • All visitors should be screened (as discussed above). If a visitor screens positive (e.g., they have symptoms) then they should not be allowed within the facility.
  • Consider limiting visitors for all patients to those who are essential (e.g., immediate family member or parent, guardian, or primary caregiver).
  • If allowed, visitor movement within the facility should be restricted to visiting the patient directly and exiting the facility directly after their visit.
  • Provide visitors with a medical mask to wear while in the facility.
  • Before entering the room of a patient on droplet and contact or other additional precautions, visitors should speak with a health care worker (e.g., patient’s nurse) first.
  • Visitors should perform hand hygiene upon entering and exiting the building and the patient room, after touching the patient or any surface in the patient’s environment, before putting on and after removing their mask.
  • The visitor policy should also be posted near visitor entrances.

Evaluate Controls

  • Regularly review the adequacy of the controls implemented and make improvements as necessary.
  • Determine if there are any new hazards created by any of the changes implemented at the workplace. For example, if workers are issued N95 respirators have they been fit tested? Review and adjust programs as necessary.

Facility Continuity Plans

  • Review and adjust facility continuity plans to address issues related to COVID-19 such as: what to do if there is a staff shortage, what to do in the event of an outbreak, what to do if there are a surge of patients, and how communication will be coordinated with stakeholders such as the jurisdiction’s Ministry of Health and local public health authorities.

It is important that mental health resources and support are provided to all workers, including access to an employee assistance program, if available.

For further information on COVID-19, refer to the Public Health Agency of Canada.

Note that this guidance is just some of the adjustments organizations can make during a pandemic. Adapt this list by adding your own good practices and policies to meet your organization’s specific needs.

Disclaimer: As public and occupational health and safety information is changing rapidly, local public health authorities should be consulted for specific, regional guidance. This information is not intended to replace medical advice or legislated health and safety obligations. Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.

Document last updated April 22, 2021