Tracking Employee Exposures to COVID-19
Transcript of Tracking Employee Exposures to COVID-19
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Tracking Employee Exposures to COVID-19
NIEHS Worker Training Program April 15, 2020
Marianne Cloeren, MD, MPH Division of Occupational & Environmental Medicine
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Disclosures
Nothing to disclose
The findings and conclusions in this report are those of the author and do not necessarily represent the views of the University of Maryland Medical Center or School of Medicine
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Acknowledgement
We acknowledge the support of the University of Maryland, Baltimore, Institute for Clinical & Translational Research (ICTR) and the National Center for Advancing Translational Sciences (NCATS) Clinical Translational Science Award (CTSA) grant number 1UL1TR003098.
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Brief Bio
Associate Professor Internal Medicine and Occupational Medicine Research on work disability risk and impact of opioids Online instructional designer Consultant on Occupational Health issues to UMB and College Park campuses
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FPI
UMB
UMMC University of
Maryland, Baltimore – Research & Education
University of Maryland
Medical Center – Patient Care
Faculty Physicians, Inc.
– OutpatientPractices
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Usual Resources for
Employees
Environmental Health & Safety but No
Employee Health UMB
UMMC
FPI
Occupational Health Nurse
Employee Health/ Infection Prevention/ Occupational Safety
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What the Pandemic Taught Us
(Ironically enough, considering social distancing…)
FPI
UMB
UMMC
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FPI – Outpatient Practices
Students, Professors, Police, Environmental
Services, Research Labs, Animal Facilities
Nurses, MAs,
Support, Techs
Nurses, Nursing Assistants,
Technicians, Food Service,
Environmental Service,
Maintenance
UMB – Education and
Research
UMMC – Medical Center – Patient Care
Physicians
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Challenges in an Overlapping World
Reporting illness and exposures
Contact tracing
Communicating risk
Duplicating effort
Dropping balls
Discordant policies
Consider an infected faculty member, who
practices in the hospital… with an outpatient
practice … and a research lab
How many campus organizations and people
may be affected?
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Planning for a Pandemic
Brought together key experts and stakeholders from all campus organizations to:
Plan response (staffing, space, supplies,equipment) Write and reconcile policies across organizations Decide on personal protective equipment and develop training Develop implementation protocols
Tabletop Exercise
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k carT o ee
d t
NCOVID-19 Diagnosis in Employees
Influenza-Like Illness in Employees
Exposure to COVID-19
Contact Tracing – Notification and Decisions
Work Absence, Quarantine Time, RTW
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Secure web application for online surveys and databases
Developed by Vanderbilt University and shared with the world
Designed to support online or offline data capture for research studies and operations
The REDCap Consortium - a vast support network of collaborators
Academic institutions and non-profit organizations share management
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The UMB COVID-19 Employee Tracking
System in REDCap
Employee COVID-19 Exposure Tracking in
REDCap
No Symptoms --> Exposure Report
Symptom Monitoring
If Symptoms --> Illness Report
Quarantine Decision Based on
Risk
Symptoms --> Illness Report
Isolate & Test (If Not Yet Tested)
COVID-19 Test Negative
Return to Work Planning
COVID-19 Test Postive
Symptom Monitoring &
Return to Work Planning
Contact Tracing
Daily Symptom Monitoring
If Symptoms --> Illness Report
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Employee enters information about exposure event – colleague at work,
home/ community, patient encounter
Employee health reviews information, interviews if necessary, determines
risk, triggers written notification with symptom monitoring plan and
decision about quarantine or return to work
Push notifications twice a day to employee to complete symptom report
If symptoms reported, flag to employee healthEmployee is directed to complete illness report and moves
to illness path and decisions
The UMB COVID-19 Employee Tracking
System in REDCap
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If employee is already having symptoms, completes information about symptoms,
onset, testing completed and results, last time at work
Employee health reviews and decides on isolation plan, facilitates access to
testing if not already done
Pathway branches depending on results of
COVID-19 testing
System pushes reminders to employee to monitor and report symptoms twice a dayReturn to work plan is based on symptom
improvement and COVID-19 status
The UMB COVID-19 Employee Tracking
System in REDCap
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If COVID-19 positive, we can trigger a self-report on contacts to support
contact tracing
Isolation period is longer, and related to days since last fever
The UMB COVID-19 Employee Tracking
System in REDCap
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Possible future feature
Tracking daily symptoms of frontline employees reporting
to work
The UMB COVID-19 Employee Tracking
System in REDCap
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Option 1
EXPOSURE REPORT
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Cloeren
And additional contact info…
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Family Medicine
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04/15/2020
Exam room B
11:00
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19. How close did you get to the patient?
20. In total, how much time did you spend with the patient
21 . Pl,ease describe piatient use of mask cov1ering nose AND mouth?
Physical Contact
C Less th1an 3 fi
c 3-6 ft
More than 6 ft reset
C On~y momentarily
C Less th1an 2 minutes
C 2-5 minutes
5-15 minutes
C Longer than 15 minutes reset
C The patient wore a mask the whole time
0 The patient put on the mask within a minute
The patient wore a 1mask part of the tiirne
The patient DID NOT put on a mask
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22. Were you wearing the following personal protective equipment during the encounter?
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Evaluating a patient for possible COVID-19. Coughed on me while getting specimen.
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Assessment of Risk and Plan
Employee health reviews, interviews employee if needed Determines risk Establishes plan for
Symptom monitoring
Return to work vs. quarantine (work at home) Timelines
Sends communication via REDCap with recommendations
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Follow-up
SYMPTOM MONITORING
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Symptom Monitoring
Automated prompts to measure temperature and document symptoms twice a day Email notification Can be sent via phone Logs responses Tracks missed responses Flags abnormal responses for employee health attention
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Symptom Monitoring Form Completed by Exposed Employee
Twice a Day
Employee Health notified by e-mail
(“flag”) if any fever or positive symptom
during post-exposure monitoring
Illness developing during post-exposure symptom monitoring
triggers prompt to report illness
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Dashboard views to review aggregate employee data Flexible report options -
customizable
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Option 2
ILLNESS REPORT
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Exp1osure Re1port Form
Pleas,e complete 'the survey below.
Tha111k you '~
lls this repo:rt an exposure or an illness?' ·1; must provide value
Please enter the information below:
Report Date
1; must provide value
1. Employ,ee Last Name
1; must orovide val 1e
1-<es1ze tont: 1±1 I B
Exposure wlthout illness
Illness with/without k11ow11 exposure reset
04- 1 5-202~ :t [ Today ] M-0-Y
Additional contact info…
Cloeren
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Working While Sick?
Family Medicine
04/06/2020
04/09/2020
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51. Please check any symptom you have had since illness onset
…
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Fever History and Known Exposures
04/12/2020
102.3
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04/09/2020
UMB Urgent Care
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Assessment & Plan
Healthcare worker who worked for 3 days while sick Tested positive Common story Plan:
Isolate until 10 days fever free Contact tracing
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13:00
Marianne Cloeren
Marianne
Cloeren
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04/09/2020
1
04/11/2020
2
Working closely with occupational health nurses to don and doff PPE for training videos
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117. How many employees have you had c:Io,se and /01r pro10 nged contact with? H ...__[A~ -----------1
(0 -20}* rr us e p ro •1id e va u e
Employee #1
H18.. Employee #1: Fi rst Name
H18-a. Emp1loyee #1: Last Nam1e
18b. Employree #1 : IPlho1ne Number H
181d. Employee #1: ~o y1our !knowledge. is th is person sk k? Yes No reset
Yes No reset
Employee #2
H 191 Employee #2: Fi rst Nam1e•
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The UMB COVID-19 Employee TrackingSystem in REDCap
Used to track COVID-19 in 2/3 organizations on campus
Current features and potential uses
Opportunities for collaboration?
REDCap Exposure Report
Triggers 14-day post-exposure symptom monitoring Push notifications, positive symptom flags and missed reports; templated guidance Link sent to employees reporting exposures or identified via contact tracing
REDCap COVID-19 Illness or Diagnosis Report
Employee completes to document COVID-19 consistent illness, test results 14-day recovery symptom monitoring for planning return to work Push notifications and missed reports; templated guidance on self-isolation Contact tracing report to document last time at work and employee contacts
REDCap Daily Symptom Monitoring (Future)
Surveillance for front-line clinicians (proposed approach) Push notifications, positive symptom flags, missed report options Templated guidance on other resources next steps if symptoms