Associate Workflow

COVID-19 Infection Prevention Playbook

Associate Workflow

Last update: 8/3/21 Updates include: Guidance for Asymptomatic Healthcare Personnel Screen and Go Process

Table of Contents

Important IDPH Information Related to COVID-19 for Associates ...... 3 AMITA Health COVID-19 Exposure Guide...... 4 Travel Information...... 5 Returning to Work ...... 11 COVID-19 Screening Guidelines...... 12 How to save a link to your device...... 16 COVID-19 Screen and Go Flow for Critical Staffing ...... 17 Corporate Office Guidelines ...... 18 3M 6000 Series Half Facepiece Flyer...... 28 3M 6000 Series Associate Guide and Donning Doffing Respirator ...... 29 3M 6000 Series Inspection Cleaning...... 33 3M 6000 Wear It Right ...... 35 3M 6000 Series Reusable Respirator-Disinfection Process ...... 36 3M 6000 Series Masks Procedure ...... 37 3M 6000 Worker Acknowledgement ...... 39 Address and Phone List ...... 40

IMPORTANT IDPH INFORMATION RELATED TO COVID‐19 FOR ASSOCIATES

Updated 5/17/2021

AMITA Health continues to update its guidance regarding COVID-19 testing and vaccination for all associates both patient facing and non-patient facing. The guidance is based on recommendations from the Centers for Disease Control and Prevention (CDC) and Illinois Department of Public Health (IDPH). The CDC is the health protection agency of the United States basing their recommendations from science. IDPH is a local body who assimilates recommendations from the CDC and applies it specifically to protect the people of Illinois based on local reaction and statistics. Detailed information is within the document. Recent and key points to remember:

• Masking is still required in health care facilities. • Health care workers are to use the COVID 19 Screen and Go application before they journey in to work and follow the directions on the screen. • If you have signs and symptoms (fever >100.4, new cough, shortness of breath, sore throat) before work, do not come to work. Notify you manager and Associate Health by phone. If you are concerned about signs and symptoms, call your primary-care physician. • If you have signs and symptoms (fever >100.4, new cough, shortness of breath, sore throat) during work, notify your manager and go home immediately. Call your primary-care physician if you are concerned about your signs and symptoms. • If you have been in direct contact with someone with COVID-19 (community exposure within 6 feet for a cumulative 15 minutes or healthcare exposure without appropriate PPE), you may be placed in quarantine by the local health department or may be allowed to work as long as you remain asymptomatic, are masked at all times, and are able to social distance. County protocols may vary.

Your health and safety are of paramount concern to AMITA Health, and we closely monitor the CDC and IDPH for COVID-19 updates. We expect the guidance to continue to change from time to time as situation continues to evolve and as advances in treatment emerge, and we will update you promptly about any new developments. We will continue to assist leaders in developing the best process in their respective areas for conservation, distribution and tracking of surgical masks across AMITA Health. Conservation of masks and other personal protective equipment (PPE) will be essential for a possible future surge of COVID-19 patients.

3 Guidance for Asymptomatic Healthcare Personnel1 (HCP) Who Were Exposed to Individuals with Confirmed COVID-19 in the Healthcare Setting Higher-risk exposures generally involve exposure of HCP’s eyes, nose, or mouth to material potentially containing SARS-CoV-2, particularly if these HCP were present in the room for an aerosol-generating procedure. Guidance for non-patient facing and corporate locations listed in Corporate Office Guidelines.

This guidance applies to HCP1 with potential exposure in a healthcare setting to patients, visitors, or other HCP with confirmed COVID-19.

Exposure Personal Protective Equipment Used Work Restrictions HCP who had prolonged2 • HCP not wearing a respirator or facemask • Exclude from work for 14 days after last exposure3 close contact with a • HCP not wearing eye protection if the person with • HCP to monitor themselves for fever or symptoms consistent patient, visitor, or HCP COVID- 19 was not wearing a cloth face covering or with COVID-19 with confirmed COVID-19 facemask • For any HCP who develop fever or symptoms consistent with (High Risk Exposure) • HCP not wearing all recommended PPE (i.e. gown, COVID-19: gloves, eye protection, respirator) while performing o If at home, do not report to work. Contact your 2 an aerosol-generating procedure manager and Associate Health. o If at work, notify your manager and immediately leave for home. contact Associate Health on the phone to notify of your symptoms. Full Vaccinated Workers N/A • Fully vaccinated HCP with higher-risk exposures who are asymptomatic do not need to be restricted from work for 14 days following their exposure and should have a series of two viral tests for SARS-CoV-2 infection immediately and 5–7 days after exposure. o People with SARS-CoV-2 infection in the last 90 days do not need to be tested if they remain asymptomatic, including those with a known contact. HCP other than those N/A • No work restrictions with exposure risk • HCP to monitor themselves for fever or symptoms described above consistent with COVID-19 • Any HCP who develop fever or symptoms consistent with COVID-19 should immediately contact Associate Health

1Healthcare Personnel (HCP): HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, volunteer personnel).

2Prolonged close contact is defined as being <6ft for >15 cumulative minutes over a 24-hour period with a COVID positive person. However, any duration should be considered prolonged if the exposure occurred during performance of an aerosol generating procedure.

3If critical staffing shortages occur, it might not be possible to exclude exposed HCP from work. If work restrictions are recommended after an exposure, consult with the ministry’s CEO, CNO and CMO to determine if the work exclusions would affect the department’s ability to deliver safe, quality care due to critical staffing. If associates are allowed to return to work after a high-risk exposure due to critical staffing shortages, they should continue to monitor themselves for fever or symptoms consistent with COVID-19 and follow universal masking protocols.

Source: Centers for Disease Control and prevention. (2021, April 27) Infection Control After Vaccination Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination | CDC 4

COVID-19 Travel Information International Travel Individuals vaccinated and unvaccinated who return from international travel are advised by the Centers for Disease Control to take the following steps after travel: • Stay home as much as possible. • Avoid being around people at higher risk for severe illness from COVID -19. • COVID 19 PCR on days 3-5 after returning • Monitor for symptoms of COVID. All workers are to use the Screen and Go Application following the prompts for International Travel checking for signs and symptoms of COVID twice a day for 14 days upon arrival back to the US.

In efforts to contain the virus, protect our patients and co-workers, health care professionals who live or work outside of Chicago and traveled internationally and have no symptoms of COVID, may return to work and use the Screen and Go application to monitor for signs and symptoms of COVID 19. Testing is required per the Centers for Disease Control for COVID 19 PCR on days 3-5 after returning by contacting their local Associate Health office.

Chicago Travel Orders

The Chicago Department of Public Health (CDPH) issued an Emergency Travel Order in response to increased and high rates of COVID-19 transmission in certain states and to add to Chicago’s efforts to contain the spread of COVID-19. The order applies to people who live and/or work in the City of Chicago.

Any person who lives or works in Chicago and traveled for personal reasons to the designated states and returned on or the specific date per state will need to self-quarantine for 10 days following their last contact with a designated state. There are certain modifications to the Order that apply to Healthcare Workers as described below. The City will review and amend the list of designated states, as necessary, every Tuesday. For the current list of states please visit Chicago Travel Order

Vaccinated persons (returning travelers who live or work in Chicago, or visitors to Chicago) who have traveled domestically are not required to quarantine if they are: --asymptomatic; and --fully vaccinated (i.e., are ≥2 weeks following receipt of the second dose in a two- dose COVID-19 vaccine series or ≥2 weeks following receipt of 1 dose of a single- dose COVID-19 vaccine). If returning travelers experience symptoms, they must self-isolate pending a COVID 19 test.

Guidance for Healthcare Workers The CDPH has modified the Order as it relates to Healthcare Workers who have traveled to a designated state for personal reasons as follows:

While CDPH recommends quarantine for 10 days from the date of return for unvaccinated healthcare workers who return from travel for personal reasons from a designated state, healthcare worker must self-quarantine but may be tested for COVID 19 PCR on days 3- 5 after returning by contacting their local Associate Health office. Associate Health will provide testing at no cost for workers without symptoms who need testing to return to work. If the test is negative, then the healthcare worker can return to work upon a negative result. Healthcare workers who can return to work will comply with the following: • Must not have had close prolonged contact with a known, confirmed case of COVID-19. • Has no known symptoms of COVID 19. • Maintain universal masking precautions while at work. • Maintain a 6-foot social distance during meal breaks while at work. • Monitor for symptoms of COVID and temperature less than 100.4 before work using the COVID-19 Screen and GO application with their smart phone or calling Ascension Connect (833) 982-0510. • If any symptoms of COVID occur, the Healthcare worker must stop working, notify their manager and Associate Health and be re-tested. 6

FAQs for the Chicago Travel Order:

What if a healthcare worker lives in a Chicago suburb, works in Chicago, travels to a designated high incidence state?

If travel is for personal reasons and the person is not vaccinated, the worker must self-quarantine and may not return to work in a Chicago hospital until day 11 or after a negative PCR COVID 19 test conducted between days 3-5 as describe above.

What if the healthcare worker lives in Chicago and works in the suburbs?

If travel is for personal reasons, the unvaccinated worker must self-quarantine and may not return to work until day 10 or after a negative PCR COVID 19 test conducted between days 3-5 upon return as describe above.

What if I had a connecting flight through one of the designated states or drove through a designated state, but did not stay there?

The Order does not apply to any individual passing through a designated state for less than 24 hours in the course of travel.

What if I don’t have any symptoms, do I still have to quarantine?

Yes.

What if I get tested and am negative – do I still have to quarantine?

Yes.

How and when will the list be updated? The list of states will be reviewed and amended every Tuesday.

What happens if I only had dose 1 of the two‐dose series, do I have to quarantine? Yes.

What does Quarantine mean?

Per CDPH, if you are do not meet the criteria for vaccination, under this Order, quarantine means staying at a single designated home for 10 days or until an negative COVID PCR tested between days 3-5 upon before doing any activities outside of the home or dwelling. People in quarantine should separate themselves from others as much as possible and check themselves for symptoms of COVID 19. Additional requirements under quarantine include:

• The individual must not be in public or otherwise leave home unless seeking medical care or COVID-19 testing. • If seeking medical care or testing, or when traveling, a face covering must be worn, and public transportation must not be used. • Food and other needed supplies must be delivered to the individual’s home; the individual may not leave the premises to acquire supplies. • The traveling individual or family group should be situated in separate quarters with a separate bedroom and, if possible, separate bathroom facility from non-traveling household members. • The individual must self-monitor for symptoms potentially consistent with COVID-19. Workers may us the COVID 19 monitoring tool twice a day or the attached symptom monitoring form. • The link to the COVID -19 monitoring tool. http://ascn.io/AscensionScreen • If any symptoms develop, the individual may leave home to receive testing for COVID-19. A face covering must be worn while seeking testing. How will I be paid during the self‐quarantine? You will have to use PTO or take a Leave of Absence, if eligible.

Can I use EIB or STD? For eligible associates, EIB or Short-Term Disability benefits can be paid when an associate opens a claim with Sedgwick due to illness. Claims can be initiated by contacting Sedgwick at 855-224-4899.

Do I need to call in a leave to Sedgwick? Sedgwick must be contacted if an associate opens a leave due to illness, the standard reporting process will be followed. If placed on a leave of absence, Associate must be cleared to return to work by Associate Health to reactive access to Kronos and status in PeopleSoft.

What do I need to do if I live or work in Chicago and traveled to a designated state and returned after traveling to a state listed on the Travel Order? You must contact your manager and advise them of this fact and will have to comply with the City of Chicago Emergency Travel Order.

What happens if I don’t tell my manager where I traveled? If you are found to have traveled to any of the states listed in the travel order, you will be sent home and you will be subject to corrective action, up to and including termination.

Are there any exceptions to the Order? For purposes of the Order, “essential workers,” which includes persons who work in Healthcare, are not subject to the mandatory self-quarantine if they are traveling for work purposes under the following circumstances: (a) If a non-resident of Chicago is traveling from a designated state to Chicago for the primary purpose of carrying out primary work in Chicago and who needs to be physically present in Chicago in order to carry out that primary work, with identification issued by their employer; or (b) If a resident of Chicago is returning from a designated state and was in the designated state for the primary purpose of carrying out primary work in that state, and who needed to be physically present in that state in order to carry out that primary work, with identification issued by their employer.

Essential workers traveling for work purposes are subject to the following requirements: • Essential workers should avoid any non-essential interactions until the quarantine period has ended. They must limit their activities to work- related activities and functions that directly support their work-related activities and avoid public spaces as much as possible. • Essential workers should monitor their temperature and signs of symptoms, wear a face covering when in public, maintain social distance, and clean and disinfect workspaces. • Essential workers are required, to the extent possible, to avoid extended periods in public, contact with strangers, and large congregate settings.

Returning to Work

Q: When can I return to work after being sick?

A: Associates may return to work after illness: HCP with mild to moderate illness who are not severely immunocompromised: • At least 10 days have passed since symptoms first appeared and • At least 24 hours have passed since last fever without the use of fever-reducing medications and • Symptoms (e.g., cough, shortness of breath) have improved Note: HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date the specimen was collected from their positive viral diagnostic test.

HCP with severe to critical illness or who are severely immunocompromised: • At least 20 days have passed since symptoms first appeared • At least 24 hours have passed since last fever without the use of fever-reducing medications and • Symptoms (e.g., cough, shortness of breath) have improved Note: HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 20 days have passed since the date the specimen was collected from their positive viral diagnostic test.

Q: When can I return to work after a confirmed positive, but I didn’t have any symptoms of COVID?

A: Associates will remain off from work for 10 days from the date the specimen was collected from their positive viral diagnostic test if you have not become ill since the date of your test. • In both instances, Associate Health will help manage your return to work sooner when safely possible.

Return to Work Practice and Work Restrictions

Q: Who should I notify when I am ready to return to work? • Notify your manager and local Associate Health when you are ready to return to work.

Q. What do I need to do when I return? • Wear a facemask and eye protection at all times while in the healthcare facility. A facemask in preferred over a home-made face cloth during this time while you are recovering.

Q: Do I need to do any self – monitoring after my illness? A: You will continue to self-monitor for signs and symptoms and seek re-evaluation if your symptoms recur or worsen.

BEFORE you leave from home to work and then in the evening. You are to check for both temperature and signs of COVID (sore throat, body aches, fever >100.4, new cough, shortness of breath, loss of taste or smell). You will need to avoid caring for immunocompromised or vulnerable patients until you complete your 14 monitoring.

Testing Q: Do I need to be tested if I have mild symptoms? A: The Illinois Department of Public Health IDPH recommends that anyone who has symptoms of COVID and/or has been potentially exposed to COVID, and if in a healthcare setting be tested.

Q: What if I have a high-risk condition such as Diabetes, Asthma, COPD, hypertension, obesity or I am pregnant and having symptoms of COVID19?

A. Please contact Associate Health who will provide direction on being tested.

Q: What if I have symptoms of COVID 19 and have concerns about people in my home?

A. Please contact Associate Health who will provide direction on being tested.

Q: Are there any special precautions for Pregnant Health Care workers? A: Information is very limited on how COVID-19 will affect pregnant health care workers. It is recommended to consider limiting exposure of pregnant health care workers to confirmed or suspected COVID-19 patients. Especially during higher risk procedures (e.g. aerosol – generating Procedures) if feasible based on staffing. Health Care workers who have concern can apply for an accommodation through rAMITA.

Monitoring for Symptoms of COVID Before Leaving for Work

All workers regardless of location are to monitor for symptoms of COVID 19 prior to work. There are three ways a worker can screen prior to work. • COVID 19 Screen and Go Application for Smart Phones • Call Ascension Connect to be screened by dialing 833-982-0510 • Complete a screening using a computer link. https://ascn.io/AscensionScreen .

COVID 19 Screening Application

Ascension has developed an application to help associates and the organization monitor the health of workers. (Instructions on the following pages.) AMITA Health has adopted this process. The link or QR code located within this document will bring you to a web page that may be used on any android or iPhone. There is now a version in the Spanish language.

Workers who do not have a smart phone may call Ascension Connect to be screened or you may log on to your computer using the link to answer the screening questions.

The application assesses workers for sign and symptoms of COVID daily prior to work and twice a day for those who have traveled internationally.

Each time the application is used, it transmits back to Associate Health. Results are as follows. Green Screen If an associate receives a green screen, the associate may proceed to work.

Yellow Screen If an associate receives a yellow screen, they are to proceed to work with the following actions: • The associate will contact the house supervisor or manager who will provide the associate with a testing packet. • The associate will take the testing packet, which contains general instructions, an order form completed by their manager and instructions on self-swabbing will fax the completed order form to registration or outpatient lab testing. • Once registered, the associate will pick up their registration information and proceed to laboratory, follow directions to self- swab and provide the specimen to the laboratory to run as a STAT. • The associate may return to work maintaining PPE and social distancing. • The laboratory will inform the house supervisor or manager if the result comes back positive. • The house supervisor or manager will then inform the associate of the positive test result, instructing them to contact their supervisor and go home. • Associate Health will be notified of the positive test result and will follow-up with the associate the next business day. • Beginning March 1, 2021, our current testing process will be updated. • If an associate refuse or fails to get COVID-19 tested, the Associate and Occupational Health team will notify the associate's manager. • Associates should be placed on unpaid administrative leave while their refusal or failure to test is escalated to Human Resources by the manager opening a case via myHR. • If an associate is declining the test due to a medical or religious reason, the HR team will work with the leader and associate on the interactive accommodations process. • If an associate is approved for exemption, he or she should be placed on a 10-day furlough and can use PTO. • Associates refusing or failing to test without an approved exemption will be terminated. • The 10-day furlough will no longer be offered. 13

Yellow Screening - Sample Information

Instructions Order Form Self Swab Information

Red Screen If an associate receives a red screen, they are asked to stay home, notify their manager and contact Associate Health for follow-up.

14 FAQs

Q: What if I've already received the COVID‐19 vaccination? Do I need to take the test?

A: Yes. If you have been instructed by Associate and Occupational Health to be tested, you are required to test. Although the vaccines are highly effective at preventing COVID-19 disease (90-95%), they are not 100% and you still may become infected, and potentially contagious with COVID-19. The test is a PCR swab (nasal swab) for the SARS CoV-2 virus. It is not an antigen or antibody test (which tests for immunity); therefore, it will not detect or interfere with vaccine immunity.

Q: How often will I or my unit need to be tested? A: Testing will be triggered under two circumstances, as needed:

a. You have symptoms (e.g., Tier 1/Red screen on Screen & Go App or Tier 2/Yellow screen on Screen & Go App) consistent with COVID-19 and testing is warranted to diagnose it. b. You work in a department or a unit that is experiencing a cluster or an outbreak, and identifying all possible positive individuals is part of the investigative process.

Q: What if I refuse due to medical or religious reasons? A: If you are refusing the test due to medical or religious reasons, your direct supervisor will go through the interactive accommodations process to determine if an exemption to the test will be granted. If approved for an exemption, you will be placed on a 10-day furlough and can use PTO.

COVID 19 Screen and Go QR CODE, Link and Ascension Connect Information

Corporate Office Guidelines

Associate Expectations

Social Distancing, Masking and Hand Hygiene

Employees should take the following steps to protect themselves at

work:

• Follow the policies and procedures of the employer related to illness, use of cloth masks, social distancing, cleaning and disinfecting, and work meetings and travel. • Stay home if sick, except to get medical care. • Practice social distancing by keeping at least 6 feet away from fellow employees or co-workers, customers, and visitors when possible. • Wear cloth face coverings, especially when social distancing is not possible.

• Employees should inform their supervisor if they or their colleagues develop symptoms at work. No one with COVID-19 symptoms should be present at the workplace. • Wash hands often with soap and water for at least 20 seconds, especially after blowing noses, coughing, or sneezing, or having been in a public place. o Use hand sanitizer that contains at least 60% alcohol if soap and water are not available. • Use hand sanitizer that contains at least 60% alcohol if soap and water are not available. • Avoid touching eyes, nose, and mouth. • To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, etc. • Where possible, avoid direct physical contact such as shaking hands with people. • Minimize handling cash, credit cards, and mobile or electronic devices when possible. • Avoid all non-essential travel.

Source: https://www.cdc.gov/coronavirus/2019-ncov/community/general-business- faq.html#Reducing-the-Spread-of-COVID-19-in-Workplaces

Cleaning of Environment Common/Hotel spacing

Cleaning and Disinfecting Your Facility Cleaning Your Facility Every Day and When Someone is Sick

The virus that causes COVID-19 can land on surfaces. It’s possible for people to become infected if they touch those surfaces and then touch their nose, mouth, or eyes. In most situations, the risk of infection from touching a surface is low. The most reliable way to prevent infection from surfaces is to regularly wash hands or use hand sanitizer. Cleaning and disinfecting surfaces can also reduce the risk of infection. Always follow standard practices and appropriate regulations specific to your type of facility for minimum standards for cleaning and disinfection. This guidance is indicated for buildings in community settings and is not intended for healthcare settings or for other facilities where specific regulations or practices for cleaning and disinfection may apply. When to Clean and When to Disinfect Cleaning with products containing soap or detergent reduces germs on surfaces by removing contaminants and may also weaken or damage some of the virus particles, which decreases risk of infection from surfaces. When no people with confirmed or suspected COVID-19 are known to have been in a space, cleaning once a day is usually enough to sufficiently remove virus that may be on surfaces and help maintain a healthy facility. Disinfecting (using U.S. Environmental Protection Agency (EPA)’s List Nexternal icon) kills any remaining germs on surfaces, which further reduces any risk of spreading infection. You may want to either clean more frequently or choose to disinfect (in addition to cleaning) in shared spaces if certain conditions apply that can increase the risk of infection from touching surfaces: • High transmission of COVID-19 in your community, • Low number of people wearing masks, • Infrequent hand hygiene, or • The space is occupied by certain populations, such as people at increased risk for severe illness from COVID-19

If there has been a sick person or someone who tested positive for COVID-19 in your facility within the last 24 hours, you should clean AND disinfect the space.

Routine Cleaning Develop Your Plan Determine What Needs to Be Cleaned Consider the type of surface and how often the surface is touched. Generally, the more people who touch a surface, the higher the risk. Prioritize cleaning high-touch surfaces.

Determine How Often To Clean • High-touch surfaces should be cleaned at least once a day. • More frequent cleaning might be needed when the space is occupied by young children and others who may not consistently wear masks, wash hands, or cover coughs and sneezes. • If the space is a high traffic area, or if certain conditions apply, you may choose to clean more frequently. 20

Determine If Regular Disinfection Is Needed

In most situations, regular cleaning (at least once a day) is enough to sufficiently remove virus that may be on surfaces. However, if certain conditions apply, you may choose to disinfect after cleaning.

Consider the Resources and Equipment Needed

Keep in mind the availability of cleaning products and the personal protective equipment (PPE) appropriate for cleaners and disinfectants (if needed).

Implement Clean High-Touch Surfaces Clean high-touch surfaces at least once a day or as often as determined is necessary. Examples of high- touch surfaces include: pens, counters, shopping carts, tables, doorknobs, light switches, handles, stair rails, elevator buttons, desks, keyboards, phones, toilets, faucets, and sinks.

Protect Yourself and Other Cleaning Staff • Ensure cleaning staff are trained on proper use of cleaning (and disinfecting, if applicable) products. • Wear gloves for all tasks in the cleaning process. • Wash your hands with soap and water for 20 seconds after cleaning. Be sure to wash your hands immediately after removing gloves. • If hands are visibly dirty, always wash hands with soap and water. • If soap and water are not available and hands are not visibly dirty, use an alcohol-based hand sanitizer that contains at least 60% alcohol, and wash with soap and water as soon as you can. • Special considerations should be made for people with asthma. Some cleaning and disinfection products can trigger asthma. Learn more about reducing your chance of an asthma attack while disinfecting to prevent COVID-19.

Disinfect Safely When Needed

If you determine that regular disinfection may be needed • If your disinfectant product label does not specify that it can be used for both cleaning and disinfection, clean visibly dirty surfaces with soap or detergent before disinfection. Use a disinfectant product from the EPA List Nexternal icon that is effective against COVID-19. Check that the EPA Registration numberexternal icon on the product matches the registration number in the List N search tool. See Tips on using the List N Toolexternal icon. o If products on EPA List Nexternal icon: Disinfectants for Coronavirus (COVID-19) are not available, bleach solutions can be used if appropriate for the surface. • Always follow the directions on the label to ensure safe and effective use of the product. The label will include safety information and application instructions. Keep disinfectants out of the reach of children. Many products recommend keeping the surface wet with a disinfectant for a certain period (see product label). • Always take necessary safety precautions. o Ensure adequate ventilation while using the product. o Wear gloves. Gloves should be removed carefully to avoid contamination of the wearer and the surrounding area. Additional PPE, such as glasses or goggles, might be required depending on the cleaning/disinfectant products being used and whether there is a risk of splash. 21

• Use chemical disinfectants safely! Always read and follow the directions on the label of cleaning and disinfection products to ensure safe and effective use. o Wear gloves and consider glasses or goggles for potential splash hazards to eyes. o Ensure adequate ventilation (for example, open windows). o Use only the amount recommended on the label. o If diluting with water is indicated for use, use water at room temperature (unless stated otherwise on the label). o Label diluted cleaning or disinfectant solutions. o Store and use chemicals out of the reach of children and pets. o Do not mix products or chemicals. o Do not eat, drink, breathe, or inject cleaning and disinfection products into your body or apply directly to your skin. They can cause serious harm. o Do not wipe or bathe people or pets with any surface cleaning and disinfection products. See EPA’s Six Steps for Safe and Effective Disinfectant Useexternal icon

Alternative Disinfection Methods • The effectiveness of alternative surface disinfection methodsexternal icon, such as ultrasonic waves, high intensity UV radiation, and LED blue light against the virus that causes COVID-19 has not been fully established. • CDC does not recommend the use of sanitizing tunnels. Currently, there is no evidence that sanitizing tunnels are effective in reducing the spread of COVID-19. Chemicals used in sanitizing tunnels could cause skin, eye, or respiratory irritation or injury. • In most cases, fogging, fumigation, and wide-area or electrostatic spraying is not recommended as a primary method of surface disinfection and has several safety risks to consider.

Clean and Disinfect Specific Types of Surfaces Soft surfaces such as carpet, rugs, and drapes • Clean the surface using a product containing soap, detergent, or other type of cleaner appropriate for use on these surfaces. • Launder items (if possible) according to the manufacturer’s instructions. Use the warmest appropriate water setting and dry items completely. • If you need to disinfect, use a product from EPA List Nexternal icon approved for use on soft surfaces • Vacuum as usual. Laundry such as clothing, towels, and linens • Use the warmest appropriate water setting and dry items completely. • It is safe to wash dirty laundry from a person who is sick with other people’s items. • If handling dirty laundry from a person who is sick, wear gloves and a mask. • Clean clothes hampers or laundry baskets according to guidance for surfaces. • Wash hands after handling dirty laundry. Electronics such as tablets, touch screens, keyboards, remote controls, and ATM machines • Consider putting a wipeable cover on electronics, which makes cleaning and disinfecting easier. • Follow the manufacturer’s instructions and recommendations for cleaning the electronic device. 22

• For electronic surfaces that need to be disinfected, use a product on EPA List Nexternal icon that meets manufacturer’s recommendations. Many of the products for electronics contain alcohol because it dries quickly.

Outdoor areas • Spraying cleaning products or disinfectants in outdoor areas – such as on sidewalks, roads, or groundcover – is not necessary, effective, or recommended. • High-touch surfaces made of plastic or metal, such as grab bars, play structures, and railings, should be cleaned regularly. • Cleaning and disinfection of wooden surfaces (such as wood play structures, benches, tables) or groundcovers (such as mulch and sand) is not recommended.

Clean and Disinfect Your Facility When Someone is Sick If there has been a sick person or someone who tested positive for COVID-19 in your facility within the last 24 hours, you should clean and disinfect the spaces they occupied.

Before cleaning and disinfecting • Close off areas used by the person who is sick and do not use those areas until after cleaning and disinfecting. • Wait as long as possible (at least several hours) before you clean and disinfect.

While cleaning and disinfecting • Open doors and windows and use fans or HVAC (heating, ventilation, and air conditioning) settings to increase air circulation in the area. • Use products from EPA List Nexternal icon according to the instructions on the product label. • Wear a mask and gloves while cleaning and disinfecting. • Focus on the immediate areas occupied by the person who is sick or diagnosed with COVID-19 unless they have already been cleaned and disinfected. • Vacuum the space if needed. Use a vacuum equipped with high-efficiency particulate air (HEPA) filter and bags, if available. o While vacuuming, temporarily turn off in-room, window-mounted, or on-wall recirculation heating, ventilation, and air conditioning systems to avoid contamination of HVAC units. o Do NOT deactivate central HVAC systems. These systems provide better filtration capabilities and introduce outdoor air into the areas that they serve. • It is safe to wash dirty laundry from a person who is sick with COVID-19 with other people’s items, if needed. • Ensure safe and correct use and storage of cleaning and disinfectant products, including storing such products securely and using PPE needed for the cleaning and disinfection products. If less than 24 hours have passed since the person who is sick or diagnosed with COVID-19 has been in the space, clean and disinfect the space.

If more than 24 hours have passed since the person who is sick or diagnosed with COVID-19 has been in the space, cleaning is enough. You may choose to also disinfect depending on certain conditions or everyday practices required by your facility.

If more than 3 days have passed since the person who is sick or diagnosed with COVID-19 has been in the space, no additional cleaning (beyond regular cleaning practices) is needed.

Additional Considerations for Employers and Facility Operators • Educate workers who clean, wash laundry, and pick up trash to recognize the symptoms of COVID-19. • Develop policies to protect and train workers before assigning cleaning and disinfecting tasks. o To protect workers from hazardous chemicals, training should include when to use PPE, what PPE is necessary (refer to Safety Data Sheet for specific cleaning and disinfection products), how to properly put on, use, and take off PPE, and how to properly dispose of PPE.

Ensure workers are trained to read labels on the hazards of the cleaning and disinfecting chemicals used in the workplace according to OSHA’s Hazard Communication standard (29 CFR 1910.1200external icon).

• Comply with OSHA’s standards on Bloodborne Pathogens (29 CFR 1910.1030external icon), including proper disposal of regulated waste, and PPE (29 CFR 1910.132external icon).

This guidance is indicated for cleaning and disinfecting buildings in community settings to reduce the risk of COVID-19 spreading. This guidance is not intended for healthcare settings or for operators of facilities such as food and agricultural production or processing workplace settings, manufacturing workplace settings, or food preparation and food service areas where specific regulations or practices for cleaning and disinfection may apply.

Reference: https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

Use of flags

While many departments residing in Lisle are operating at reduced capacity, Navistar Facilities will be installing blue flags at each workstation and office on AMITA floors. This will allow our janitorial crew to clean and disinfect populated areas more effectively. This will also improve efficiencies going forward when employees are traveling, on vacation, on leave, or using unassigned workstations.

All common areas and restrooms continue to be disinfected each evening Monday through Friday regardless of low occupancy.

Occupancy flags will be installed beginning Wednesday December 3rd and continue over several days. Please notify your employees so they are aware of the process

The process is simple:

1. When you arrive to your desk, raise the flag and leave it up. 2. Leave your flag up when you depart for the day. This lets the cleaning staff know which workstations were used that day so we can ensure that all are thoroughly cleaned. 3. Please keep the workstations clutter free to accommodate the cleaning process. The cleaning staff will lower the flag so that you know the workstation was cleaned the night before. 4. Recycling will continue to be removed for all desks on Fridays only. 5. If you do not raise your desk flag, your workstation trash container will not be emptied.

Meetings

New Meeting Guidelines

• Meeting attendance size is now relaxed to allow more than 10 at a meeting, if the room size allows. • Masking, social distancing, and hand hygiene remain in place for meetings in healthcare settings. • Conference room capacity, with 6 foot social distancing, will be determined using this calculator: https://www.banquettablespro.com/social-distancing- room-space-calculator • Facilities/MedXcel have determined the square footage of all the conference rooms • “COVID Capacity” of meeting spaces will be posted on the AMITA COVID website.

Post Exposure Process – Corporate and Office Settings

In the event a worker has reported for work and during the day becomes ill and/or and has worked two days prior to being diagnosed COVID positive, a post exposure process will be implemented.

Workers with a positive COVID test must immediately contact their manager and Associate Health by phone. The manager, Associate Health and Infection Prevention will work a plan to notify any workers the positive worker may have encountered and exposed to the COVID + worker.

• The manager will assess who may have been exposed, provide a list of names to Associate Health. • The manager will notify the associates of the exposure but must not disclose the COVID positive workers information when notifying other workers. • Associate Health will contact the workers and provide guidance and opportunity to be screened for COVID 19 at no cost to the workers in the recommended time frame. • Local health department and/or CDC guidelines will be used for post exposure management including work restrictions, laboratory testing and prophylaxis. • Workers are to continue to screen for symptoms of COVID prior to coming into work. • If an exposed associate should begin to experience symptoms of COVID 19, they are to stay at home and contact Associate health for further direction.

Pre-use Reminders • Fit testing must be performed before each new respirator model is used, and at least annually • These are not surgical masks and will not maintain the sterile field. Do not wear a surgical mask in combination with this respirator, as it may affect respirator function • It is common to assign a facepiece to an individual for use as their own personal facepiece for the duration of the product life • Associa tes should label the respirator with their name using a permanen t marker

Pre-Use Inspection • Perform hand hygiene and use other applicable PPE as determined by your market and/or infection control policy • Do not wear if parts are damaged, defective, or missing.

Hardcase Filter (7093) • Inspect each filter case for any visible damage. Replace filter(s) if any damage is observed.

I . ,

Front of hardcase filter Back of hardcase filter

Facepiece • Inspect the facepiece for cracks, tears, dirt and distortion. If damage is observe d, replace the facepiece.

«:> 3M2020

2 - 4/28/20

Facepiece Inhalation Valves • Examine inhalation valves for signs of distortion, cracking and teari ng. Replace with new inhalation valves if signs of damage are observed.

In ha lation valves in facep iece interior

Facepiece Exhalation Valve • Examine exhalation valves for signs of distortion, cracking and teari ng. Replace with new exhalation valves if signs of damage are observed.

Facepiece Head Straps & Filter Gaskets

Ensure orange filter gaskets are properly Ensure head straps are intact and have seated and in good condition. Replace good elasticity. Replace head harness gasket(s) if signs of damag e are if signs of damage are observed. observed .

Respirato r Assemb ly

3- 4/28/20

1. Align mark on back side 2. Rotate filter X turn Facepiece with 7093 filters of 7093 filter with clockwise until itis properly attached. Note: facepiece mark in order to firmly seated. Repeat Rotate fil ters properly align filters. steps 1-2for second counterclockwise to filter. remove.

Respirator Donning

• Donning Instructions must be followed each time the respirator is worn. • Perform hand hygiene and use other applicable PPE as determ ined by your facility and/or infection control policy • Contact infection prevention at your facility with any questions regarding when PPE, such as gloves, should be worn • Do not use with beards, other facial hair, or other conditions that prevent a good seal between the face and the face seal of the respirator. • To help maintain a good seal between the face and face seal, all hair, hoods, or other equipment must be kept out of the respirator face seal area at all times. • Position facepiece low on the bridge of your nose for optimal visibility and best fit.

1. Place the respirator 2. Pull the head ha mess 3. Connect the bottom over over your mouth and crown of your head. straps at the back of the Position facepiece low neck. nose. on the bridge of your nose for optimal visibility and best fit. Re sp irator Donning - Adjusting Fit

• The respirator should be comfortable and snug, but do not overtighten. • Overtightening does not create a better fit; it just makes the respirator more uncomfortable. © 3M 2020 4 - 4/28/20 31

1.Adjust top straP.S by 2. Adjust bottom pulling on ends of straps by pulling on straps. ends of straps.

User Seal Check • Perform a positive pressure seal check before each use o Place palm over exhalation valve cover and exhale gently. o If facepiece bulges slight ly and no air leak is detected between f acepiece and face, a proper seal has been obtained.

o If face seal leakage is detected, reposition respirator on your face and/or readjust tension of the elastic strap to eliminate leakage until tight seal is maintained. o If you cannot achieve a proper fit, do not enter the contaminated area. See your supervisor.

3M2020

5 - 4/28/20

Respirator Doffing • Remove gloves and perform hand hygiene and use other applicable PPE as determined by your facility and/or infection control policy • Contact infection prevention at your facility with any questions regarding when PP. Such as gloves. shoul d be worn

1. Unhook straps from around 2. Grasp the front of the facepiece wit h one hand, and base of neck with other hand pull head harness and remove it from overhead

Note: After removing the respirator, perform hand hygiene Respirator Disinfection • Perform hand hygie ne and use other applicable PPE as determined by your facility and/or infection control policy • Contact infection prevention at your facility with any questions regarding when PP. Such as gloves. should be worn • Cleaning and disinfection must take place after each removal of the device and at the end of the shift. • The device should also always be cleaned and disinfected after use in an aerosol generating procedure on an isolation patient Disinfection: Wipe Down • Wipe down of the assembled respirator can be considered between uses during the work shift • Wipe each component: o Face piece, including interior and exterior o Head harness o Hardcase filter (7093) Do not wipe filter media

Interior Exterior Head harness

Do not wipe Respirator Wipe Down Disinfection Steps • Clean

6 - 4/28/20

o If gross contamination or facial oil is present. perform a cleaning wipe step before disinfection o Periodic wiping with a cloth dampened with water will help reduce buildup of disinfection agents. • Disinfect o Follow the disinfectant user instructions and/or EPA label for the selected disinfectant o Bleach or quaternary ammonia solution can be considered • Dry o Let air dry. Do not reuse until completely dry.

Filter Replacement • The 7093 filter should be replaced when damaged or difficult to breathe though, or when indicated by your facility's infection control policy. Filters should be changed at a minimum of every 90 days. • If it is difficult to breathe when wearing the respirator, the filter should be replaced.

Storage • Follow-up with local Infection Prevention on storage procedures within your facility • The respirator should be stored away from contaminated area or hung on a hook between uses • You can consider storing the respirator with the filters attached or with the filters in a separate storage container. • If not being used immediately. respirators should be sto red in their own separate. breathabl e containers or hung on hooks to prevent facepiece deformation. • Storage containers should be disposed of or cleaned regularly

Items to Remember • The 6000 Series Half Facepiece Respirator is for a single user unless directed otherwise by Occupational Health and Infection Prevention • This respirator will be heavier than an N95 Respirator or surgical mask • While wearing this respirator your voice may be muffled or you might experience some difficulty speaking • These are not surgical masks and will not maintain the sterile field. Do not wear a surgical mask in combination with this respirator, as it may affect respirator function • Associates receiving this respirator commit to proper cleaning, disinfection, labeling, storage requirements and safe keeping of the device.

7- 4/28/20

AMITA Health Associate and Occupational Health 3M 6000 Series Masks Procedure

DISTRIBUTION • Priority to frequent N95 users and/or high-risk situations or those with poorly fitting disposable N95 masks. High risk/ high volume users include but not limited to the ED, ICU, COVID Units, Respiratory and Laboratory. Includes physicians in these areas. • As masks become available, they can be provided to those areas with limited, but direct patient care to COVID + patients. Mask expiratory valve must be covered with a flat mask. • Masks are not approved for Surgical Areas. • Automated spreadsheet for tracking mask distribution o Enter the fit test into Pure OHS –Under Fit testing • Have worker sign the acknowledgement form.

Medical Evaluation • Current medical evaluation may be used for the 3M 6000.

Fit Testing

• Fit testing must occur to validate a comfortable fit and seal. • If the mask is not fitting well, you can move to another size mask. • The failed mask needs to be cleaned and reprocessed before it can be used again.

User Education and Training

• Provide the worker a training video or handout on proper use of the mask.

• 3M 6000 Series Half Facepiece Respirator Training Presentation

• 3M™ 6000 Series Half Facepiece Respirator with 7093 Filter (Assembly, donning and doffing) • Interim Disinfection 3M™ 6000 Series Half Facepiece Respirator (Features two filter types)

Key Item for worker education.

• Maximum use of filters – 3 months or if they get wet or issues with airflow • Daily Cleaning process • Wipe down at shift end, air dry according to the wipe used, leave them in their locker, they should not take them home, they should not leave the hospital unless they are floating to another AMITA Ministry. o Each site is to use their own approved disinfectant wipes o Follow manufacturer recommendations o No alcohol o Bleach wipes are fine; follow dwell time o If sensitivity exists, wipe down with plain water after cleaning and appropriate dry time. o Label filters with name and date of needed filter change (relabel if ink comes off during cleaning) 37 o Replacement parts and strap information in table below. o Advise the worker they need to educate the patient they are working with of the mask to decrease patient anxiety; perhaps post pictures o Protective skin protection products o Mepilex Lite might be applied to nose bridge to help prevent skin breakdown

Associate Health OSHA Mandatory FIT testing form (In Compliance with revised OSHA Respiratory Protection Standard 1910.134)

Associate Information:

Name

DOB or Associate ID#

3M 6000 series mask size:

 6100, Size Small  6200, Size Medium 6300, Size Large

 I did watch and read all the educational materials provided to me by my manager, and I understand that I take the responsibility of taking care, properly storing, cleaning and maintained on my 3M 6000 series mask.

 I understand that I am responsible for the mask while it is in my possession, and I will make sure that the mask always remains at my ministry. I will store as instructed.

 I understand that my department will replace the mask if the mask is lost or stolen.

Associate signature: Date:

(AOH to attach to fit test form upon receipt)

Associate Health Address and Phone List

Ministry Phone Address

500 Remington Blvd. AMITA Health Adventist Medical Center Bolingbrook 630.312.6304 Bolingbrook, IL 60440

701 Winthrop Avenue AMITA Health Adventist Medical Center GlenOaks 630.545.6192 Glendale Heights, IL 60139

120 N. Oak Street AMITA Health Adventist Medical Center Hinsdale 630.856.7342 Hinsdale, IL 60521

5101 S. Willow Springs Road AMITA Health Adventist Medical Center La Grange 708.245.7340 La Grange, IL 60525

AMITA Health Alexian Brothers Behavioral Health Hospital 1786 Moon Lake Blvd., Ste. 102 847.230.3539 Hoffman Estates, IL 60169

850 Biesterfield Road AMITA Health Alexian Brothers Medical Center Elk Grove Village 847.981.3520 Brock Building, Ste 2001 Elk Grove Village, IL 60007

1400 E. Golf Road, Ste. 124 AMITA Health Holy Family Medical Center Des Plaines 847.297.1800 x1149 Des Plaines, IL 60016

1325 N. Highland Avenue AMITA Health Mercy Medical Center Aurora 630.801.2725 BHS Bld. #4, Rm 109 Aurora, IL 60506 40

7447 W. Talcott Avenue AMITA Health Resurrection Medical Center Chicago 773.990.7624 Professional Bld., Rm. 242 Chicago, IL 60631

355 Ridge Ave., Rm. 3100 AMITA Health Saint Francis Hospital Evanston 847.316.6260 Evanston, IL 60202

2900 N. Lake Shore Drive AMITA Health Saint Joseph Hospital Chicago 773.665.3134 Medical Office Bld., Rm. 420 Chicago, IL 60657

77 N. Airlite Street, Rm. 318 AMITA Health Saint Joseph Hospital Elgin 847.695.3200 x2880 OR x5123 Elgin, IL 60123

333 N. Madison Street AMITA Health Saint Joseph Medical Center Joliet 815.725.7133 x3499 Joliet, IL 60434

2233 W. Division St., Rm. 141 AMITA Health Saints Mary and Elizabeth Medical Center Chicago 312.770.2899 Chicago, IL 60622

1555 Barrington Road AMITA Health St. Alexius Medical Center Hoffman Estates 847.490.2520 Doctor's Bld. #1, Ste. 545 Hoffman Estates, IL 60169

500 W. Court Street AMITA Health St. Mary's Hospital Kankakee 815.937.2262 Kankakee, IL 60901