Guidance and responses were provided based on information known on 7/14/2021 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and NE DHHS guidance for updates.

Infection Prevention Updates for Acute Care and Outpatient Settings

July 14, 2021 Questions and Answer Session • Use the QA box in the webinar platform to type a question. • Questions will be read aloud by the moderator as time allows. • If your question is not answered during the webinar, please e-mail it to ICAP or call during our office hours to speak with one of our Infection Preventionists (IPs). • Slides from today are available on our ICAP website, and the recording will be posted too. • https://icap.nebraskamed.com/coronavirus/ • https://icap.nebraskamed.com/covid-19-webinars/ Presenters : Gary Anthone, MD [email protected] Jean Ellis, RN, BSN [email protected] Alice Sato, MD, PhD [email protected] Rebecca Martinez, BSN, BA, RN ,CIC [email protected]

Panelists: Daniel Brailita, MD [email protected] Jody Scebold, EdD, MSN, RN [email protected]

Moderator: Margaret Deacy [email protected] Learning Objectives

During this series, participants should be better able to: 1. Recognize infection prevention and control issues for application of the recommendations to mitigate these issues. 2. Identify resources on infection prevention and control that will be helpful to mitigate infection prevention and control challenges. 3. Describe latest updates on COVID-19 pandemic related to infection prevention and control practices in acute and outpatient settings.

Target Audience

Healthcare professionals working in acute and outpatient settings. To include medical directors, nursing staff, directors of nursing, infection preventionists, quality program leaders, administrators, consultant pharmacists or other staff working in long-term care settings. Mission and Goals

To provide an educational venue that connects infection preventionists and providers from acute and outpatient facilities across Nebraska with the objective of promoting the latest research and best practices in infection prevention and control. These educational webinars are aimed to help promote and strengthen the Nebraska infection prevention and control infrastructure.

The goals for this educational activity include: 1. Increase knowledge of infection control processes for acute and outpatient settings. 2. Increasing awareness of specific infection prevention and control issues that may be confronted in acute and outpatient settings. 3. Provide resources to attendees to help them with infection prevention and control efforts in their own facilities. 4. Provide resources to attendees on the most up to date COVID-19 pandemic related guidance and recommendations. Continuing Education

1.0 Nursing Contact Hour is awarded for the LIVE viewing of this webinar​ is approved as a provider of nursing continuing professional development by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

In order to obtain either contact hour, you must be present for the entire live webinar and complete the post webinar survey​

No conflicts of interest were identified for any member of the planning committee, presenters or panelists of the program content​

This CE is hosted by Nebraska Medicine and UNMC along with Nebraska ICAP and Nebraska DHHS​ Continuing Education

1.0 AMA PRA Category 1 Credit™ for Physicians offered by UNMC is awarded for the live viewing of this webinar

In support of improving patient care, University of Nebraska Medical Center is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

The University of Nebraska Medical Center designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure Declaration

As a jointly accredited provider, the University of Nebraska Medical Center (UNMC) ensures accuracy, balance, objectivity, independence, and scientific rigor in its educational activities and is committed to protecting learners from promotion, marketing, and commercial bias. All faculty, planner and others in a position to control continuing education content participating in an accredited continuing education activity are required to disclose all financial relationships with ineligible companies. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. The accredited provider is responsible for mitigating all relevant financial relationships in accredited continuing education. Disclosure of these commitments and/or relationships is included in these activity materials so that participants may formulate their own judgments in interpreting its content and evaluating its recommendations.

This activity may include presentations in which faculty may discuss off-label and/or investigational use of pharmaceuticals or instruments not yet FDA-approved. Participants should note that the use of products outside currently FDA-approved labeling should be considered experimental and are advised to consult current prescribing information for FDA-approved indications. All materials are included with the permission of the faculty. The opinions expressed are those of the faculty and are not to be construed as those of UNMC.

The accredited provider has mitigated and is disclosing identified relevant financial relationships for the following faculty, planners, and others in control of content prior to assuming their roles:

FACULTY The faculty have nothing to disclose: Gary Anthone, MD Jean Ellis, BSN, RN Alice Sato, MD, PhD

Rebecca Martinez, BSN, BA, RN, CIC

PLANNING COMMITTEE The planning committee members have nothing to disclose: Daniel Brailita, MD Rick Starlin, MD Jody Scebold, EdD, MSN, RN Margaret Deacy Nebraska DHHS Updates Gary Anthone, MD Chief Medical Officer, DHHS

• Increase 28 pts (+19,-7,-2,-19,-7,-24,-17) • 14 day average of 1.8% of staffed beds occupied by Covid Pts (1.1,0.7,0.8,1.1,1.2) • 32% of hospitalized COVID pts in ICU (33,33,18,27,21) • 38% of COVID ICU pts on Vents (40,22,67,58,54) • 7% of statewide ICU pts are COVID pts (5,3,2,4,3)

• Average of 8 new covid pts admitted per day(6,4,7,5,5) Variants of Concern in Nebraska

Variants of Concern & Sequencing • B1.617 (delta) remains predominant • B1.617 (delta) • 40/119 (33%) are vaccine breakthrough infections • 1/119 (1%) is a potential reinfection • 11 hospitalized, 0 hospitalized vaccine breakthroughs • P1 (gamma) • 23/63 (37%) are vaccine breakthrough infections • 3/63 (5%) are potential reinfections • 7 hospitalized, 3 hospitalized vaccine breakthroughs

Public Health Fusion Cell | 12 Hospitalizations for COVID-19 are overwhelmingly among unvaccinated individuals Very few fully-vaccinated individuals are being hospitalized CyncHealth hospitalization data

1/1/21 – 6/19/21 – 7/10/21 7/10/21 (past 4 weeks) Not fully-vaccinated 2,021 (98%) 54 (93%) hospitalizations VBT hospitalizations 48 4 Total new hospitalizations available 2,069 58 in CyncHealth

Public Health Fusion Cell | 13 Nebraska DHHS Updates Jean Ellis, RN, BSN Program Manager II, Public Health, DHHS Do I still need to wear a mask in a healthcare facility?

• Visitors, regardless of their vaccination status, should wear a well- fitting cloth mask, facemask, or respirator for source control • In general, fully vaccinated HCP should continue to wear source control while at work. However, fully vaccinated HCP could dine and socialize together in break rooms and conduct in- person meetings without source control or physical distancing. If unvaccinated HCP are present, everyone should wear source control and unvaccinated HCP should physically distance from others. • Source: CDC’s Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination (4/27/2021) • CMS is still requiring a COVID-19 Focused Infection Control Survey for all Recertification and IC related Complaint surveys Do I still need to wear a mask in a healthcare facility?

• https://www.cdc.gov/coronavirus/2019- ncov/hcp/infection-control-after- vaccination.html#anchor_1619116532180

• https://www.cms.gov/medicareprovider-enrollment- and-certificationsurveycertificationgeninfopolicy-and- memos-states-and/revised-covid-19-focused-infection- control-survey-tool-acute-and-continuing-care • Jean Ellis, RN, BSN | Program Manager II • OFFICE: 402-471-0687 EMAIL: [email protected] Questions and Answer Session #1 Please use the QA box in the webinar platform to type a question

Questions will be read aloud by the moderator in the order they are received

A recording of the discussion will be made available on the ICAP website

Panelists: Gary Anthone, MD Jean Ellis, RN, BSN COVID-19 and Pediatric Vaccination Alice Sato, MD PhD (she/her/hers) Hospital Epidemiologist, CHMC Assistant Professor, Pediatric Infectious Disease, UNMC @asato4kids Objectives

• Review of SARS-CoV-2 DISCLOSURES: epidemiology with a focus on • No financial COI children and variants of concern • I am a sub-investigator in the Pfizer • Vaccination in children: safety and mRNA vaccine trial for children age efficacy in 12+ 6mo-11yo (CHMC/PRO) and • Vaccination in children: trials for Novavax trial age 12-17 (UNMC) younger children • I will discuss EUA use of COVID vaccines

Trial results

Pfizer-BioNTech Moderna xkcd Real World Effectiveness of COVID-19 mRNA Vaccines in the Nebraska 5/20/21 Nebraska 5/25/21

7/1-7/8: children represented 22.3% (19,482/87,374) of the weekly reported cases US Pediatric COVID-19 cases as of 7/1/21 Over 4 million pediatric confirmed cases o 5374 cases/100,000 children (~1 in 19)

0.9% hospitalization rate (cumulative)

335 confirmed deaths o top 10 cause of death age 12-15

Nebraska Nebraska Nebraska DELTA: o Higher viral load o Earlier shedding, shorter incubation period o Secondary attack rate much higher than strain, increased risk in households and close contact o Less anosmia, more URI symptoms o Increased hospitalizations, ICU admissions, death @boghum a 7/13/21

Douglas County 7/11/21 Douglas County 7/11/21 7/10 5.3%

6/5 1.4% Douglas County 7/12/21

Douglas County 7/11/21 Nebraska:

NYT 7/13/21

Pediatric vaccination • Initial Pfizer mRNA vaccine EUA (December 2020) allowed for ages 16+

• Subsequent Pfizer granted EUA extension (May 2021) to use mRNA vaccine in children 12-15

• Moderna mRNA vaccine EUA (December 2020) for age 18+

• Moderna has submitted for extension to ages 12-17 COVID-19 vaccination recommendations for children

•AAP supports CDC recommendation for COVID-19 vaccination in adolescents 12 years and up

•Individuals should receive the first vaccine available to them in their community (no preference apart from CDC guidance)

•AAP supports co-administration of COVID-19 vaccine with other routine childhood immunizations

•AAP actively advocated for inclusion of pregnant/lactating women and children in vaccine clinical trials

•https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/covid-19-vaccine-for-children/about- the-covid-19-vaccine-frequently-asked-questions/

Statement co-signed by: DHHS, CDC, AAFP, AAP, ACOG, ACP, AHA, AMA, ANA, APhA, APHA, APHL, ASTHO, Big Cities Health Coalition, Council of State and Territorial Epidemiologists, IDSA and NACCHO

“…The facts are clear: this is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination. Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment. In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19, and the risks to the heart from COVID-19 infection can be more severe.

The vaccines are safe and effective, and they prevent COVID-19 illness. They will help protect you and your family and keep your community safe. We strongly encourage everyone age 12 and older who are eligible to receive the vaccine under Emergency Use Authorization to get vaccinated, as the benefits of vaccination far outweigh any harm. Especially with the troubling Delta variant increasingly circulating, and more readily impacting younger people, the risks of being unvaccinated are far greater than any rare side effects from the vaccines. If you get COVID-19, you could get severely ill and be hospitalized or even die. Even if your infection is mild, you or your child could face long-term symptoms following COVID-19 infection such as neurological problems or diminished lung function.”

Clinical trial details

Moderna https://clinicaltrials.gov/ct2/show/NCT04796896?term=pediatrics&cond=covid-19+vaccine&draw=2&rank=2 NCT04796896 6 months to 11 years: recruiting 7050 participants 12 to <18 years: done recruiting 3732 participants

Novavax** https://clinicaltrials.gov/ct2/show/NCT04611802?term=pediatrics&cond=covid-19+vaccine&draw=2&rank=3 SARS-CoV-2 rS with Matrix-M1 adjuvant NCT04611802 12-17 years expansion 33000 participants (total with adults)

Pfizer *** https://clinicaltrials.gov/ct2/show/NCT04816643?term=pediatrics&cond=covid-19+vaccine&draw=2&rank=7 6 months to 12 years: recruiting 4644 participants Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel Listed societies support:

“COVID-19 vaccination should be a condition of employment for all healthcare personnel.” 7/13/21 bit.ly/3wBDC3n

Questions and Answer Session #2 Please use the QA box in the webinar platform to type a question

Questions will be read aloud by the moderator in the order they are received

A recording of the discussion will be made available on the ICAP website

Panelists: Alice Sato, MD, PhD Daniel Brailita, MD Rebecca Martinez, BA, BSN, RN, CIC Jody Scebold, EdD, MSN, RN Jean Ellis, RN, BSN Situational De-escalation Rebecca Martinez, BSN, BA, RN, CIC How It Happens

https://nebraskapublicmedia.pbslearningmedia.org/resource/ ket-pd-deescalation4/the-escalation-cycle/ Active Listening

https://reddotalert.com/6-techniques-to-de-escalate-a-threatening-situation/ https://www.nuemblog.com/blog/verbal-deescalation https://www.nuemblog.com/blog/verbal-deescalation Another De-Escalation Resource

On July 13, 2021 Project ECHO and the University of Nebraska College of Public Health facilitated a presentation by Charlotte Evans, MA about verbal de-escalation in healthcare.

The slide desk will be posted later this week on their website https://www.unmc.edu/publichealth/centers/cbbeid/Project_ECHO/criti cal_access_hospitals.html Nebraska ICAP Updates Nebraska ICAP Acute & Outpatient Assessments Office Hours & Phone Number Joint CDC and FDA Statement on Vaccine Boosters – 7/8/21 The United States is fortunate to have highly effective vaccines that are widely available for those aged 12 and up. People who are fully vaccinated are protected from severe disease and death, including from the variants currently circulating in the country such as Delta. People who are not vaccinated remain at risk. Virtually all COVID-19 hospitalizations and deaths are among those who are unvaccinated. We encourage Americans who have not yet been vaccinated to get vaccinated as soon as possible to protect themselves and their community.

Americans who have been fully vaccinated do not need a booster shot at this time. FDA, CDC, and NIH are engaged in a science-based, rigorous process to consider whether or when a booster might be necessary. This process takes into account laboratory data, clinical trial data, and cohort data – which can include data from specific pharmaceutical companies, but does not rely on those data exclusively. We continue to review any new data as it becomes available and will keep the public informed. We are prepared for booster doses if and when the science demonstrates that they are needed. https://www.fda.gov/news-events/press-announcements/joint-cdc-and-fda- statement-vaccine-boosters Topics for Next Webinar 7/28

CDC Updates

Water Management Plan

Answers to Acute and Outpatient Questions Received ICARs for Acute & Outpatient Settings • Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control practices and guide quality improvement activities (e.g., by addressing identified gaps) • ICAP is offering tele (virtual) assessments to both acute and outpatient settings • ICAP is offering full, on-site, infection control ICAR assessments for outpatient settings

• Call NE ICAP at 402.552.2881 to be connected with an Infection Preventionist • Or scan the QR code

• Ask to be added to the ICAP email distribution list​ • https://nebraskamed.formstack.com/forms/add_me_to_email_distribution_list Infection Prevention and Control Hotline Number: Call 402-552-2881 Office Hours are Monday – Friday 8:00 AM - 4:00 PM Central Time

On-call hours are available for emergencies only Weekends and Holidays from 8:00 AM- 4:00 PM **Please call the main hotline number only during on-call hours** Firstline Resources:

https://www.cdc.gov/infecti oncontrol/projectfirstline/in dex.html

https://www.facebook.com/ CDCProjectFirstline The power to stop infections. Together. https://www.facebook.com/ NebraskaICAP Every frontline healthcare worker deserves to understand infection control principles and https://www.facebook.com/ protocols and feel they can confidently apply NebraskaICAP them to protect themselves, their facility, their family, and their community. CDC’s new infection control training collaborative, Project Firstline, is designed to help every frontline healthcare worker gain that knowledge and confidence. New ICAP Podcasts!

Apple Podcasts: Amazon Music: https://podcasts.apple.com/us/podcast/the-mouthy- https://music.amazon.com/podcasts/769c29a8-1e71- ip/id1573465413 46a5-9ab3-94020d7af1f7/DIRTY-DRINKS Spotify: https://open.sp Apple Podcasts: otify.com/show/2evXIrvZFiZFP2VZBq9cVK?si=DVhPE https://podcasts.apple.com/us/podcast/dirty- ewJSL2xXIrDi0Y2Bg&dl_branch=1 drinks/id1574937193 Amazon Music: Podchaser: https://www.podchaser.com/podcasts/dirty- https://music.amazon.com/podcasts/2bc794ab- drinks-1963455 59af-4bbe-a8df-6a72309fa024/THE-MOUTHY-IP Spotify: Podchaser: https://open.spotify.com/show/3Y8w2YVedZYnX8ZS897mU https://www.podchaser.com/podcasts/the-mouthy- 9?si=lyBNetUTTSGtlg3PmBH3Tg&dl_branch=1 ip-1955086 Webinar CE Process

1 Nursing Contact Hour is awarded by NE Medicine * * Nebraska Medicine is approved as a provider of nursing continuing professional development by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 1 AMA PRA Category 1 CreditTM for Physicians offered by UNMC

CNE Nursing Contact Hours: AMA PRA Category 1 Credit™ ➢ Completion of survey is required. Completion of survey is required. ➢ The survey must be specific ➢ The survey must be specific to to the individual obtaining the individual obtaining credit. credit. (i.e.: 2 people cannot (i.e.: 2 people cannot be listed be listed on the same survey) on the same survey) ➢ One certificate is issued monthly ➢ One certificate is issued monthly for for all webinars attended all webinars attended ➢ Certificate comes directly from ➢ Certificate can be downloaded from ICAP via email the UNMC CCE system directly, they ➢ Certificate is mailed by/on the 15th will email you access of the next month ➢ Survey functionality is lost on mobile ➢ Survey functionality is lost on devices mobile devices