COVID 19: New and Updated Information and Resources
NJAASC has curated authoritative information and a list of resources for our Membership’s reference. We will continue to update this as more information becomes available.


PAST COVID E-BLAST HAVE BEEN ARCHIVED DUE TO SPACE RESTRAINTS AND TO KEEP THINGS CURRENT. 
TO VIEW PREVIOUS E-BLASTS, CLICK HERE

WITH PPE-IT’S NO LONGER BUSINESS AS USUAL- 5/5/20
I wanted to begin the conversation about how we will need to function when electives come back- and they will. There will be changes, and we need to adapt to what will be the new normal.
In speaking with and listening to the Governor’s Office, DOH and others, PPE is a large part of that discussion- as it should be.
NJAASC will begin a series of articles and instruction for ASCs, centering on correct use, conservation, re-use and repurposing and if applicable cleaning of PPE.
 
While the supply chain has improved, it is not nearly back to normal. Some could make the argument that opening up for electives only exacerbates an already tenuous PPE situation.
No matter the argument, there is still PPE ‘rationing’ going on from suppliers, with ASCs (correctly by the way) receiving less of an allotment than hospitals. Taking that and the formation of a regional governor’s purchasing group formed for the purpose of stockpiling against future outbreak into consideration, the situation is not likely to change.
 
So what can ASCs do?
 
First and foremost would be conservation. We have to learn to use only what we need and re-purpose if possible and safely.
We also have to completely understand what specific PPE is appropriate for health care providers depending upon the patient circumstance. 
 
To that end, please refer to the CDC document below, which was referenced by NJDOH in a previous COVID e-blast: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

QUESTION FROM GOVERNOR MURPHY’S COVID UPDATE TODAY- 5/5/20
In his daily Covid updates, the Governor always takes questions from the press at the end of the program.
Today he was asked about elective surgery, when would they resume.
His exact quote was: ‘Sooner rather than later’.
It is coming!

JOINT COMMISSION ON MANAGING COVID IN AMBULATORY ENVIRONMENT -5/5/20

AGA ISSUES GUIDANCE - 5/5/20
American Gastroenterological Association released guidelines on consultative management of COVID patients.

DRUG SHORTAGES AND COVID - 5/5/20
With resuming electives on the horizon, the FDA has issued a shortage list of over one hundred drugs.

LEAPFROG SAFETY GRADES- APPROPRIATE AT THIS TIME? – 5/4/20
Leapfrog put out its hospital safety grades, though some believe it is inappropriate during the COVID crisis, and unfair.
 
NJAASC met with the Leapfrog representatives in New Jersey the other month and expressed our extreme displeasure with their ASC roll out. We told them that in all good conscience we could not recommend that New Jersey ASCs participate until Leapfrog actually listens to the ASC community, and realizes that we are not hospitals!

HEALTH CARE COVERAGE AND COVID- 5/4/20
There is a growing concern that millions may lose health care coverage due to the crisis and people losing their jobs.


INFORMATION ON COVID TESTING AND SEROLOGY FROM DOH – 4/30/20
I am familiar with the document you’ve attached. http://njaasc.org/wp-content/uploads/2020/04/COV2-Antibody-Testing-1.pdf

The serology testing is a source of confusion for many.
 
If you would like to do a serology test there are 4 waived FDA/EUA test at this time. They are presumptive tests. The serology tests require a Certificate of Compliance as they are moderately complexed and a NJ State Laboratory License. You can contact  joan.mikita@doh.nj.gov  for an application and information.
Read the package insert for type of specimen before buying any serology test as many are not approved for finger stick/capillary blood. If you would like to perform the test on capillary blood the test would then elevate to high complexity and Performance Specifications would be necessary to validate the test method.
This would include method comparison, accuracy, sensitivity and specificity.
 
At this time there are 3 FDA/EUA waived/POC tests that can be used with a Certificate of Waiver. They are molecular and will let the user know if the patient has COVD19 at that time.
 
The FDA/EUA web site lists all tests approved at this time and changes daily.
Unfortunately a lot of mis-information has been provided by sales representatives and is not accurate.
 
I hope I have answered your question.

Melanie Rinaldi
Manager of CLIA program
Clinical Lab Evaluator 3
Off: 609-406-6832
Fax 609-406-6827

NEW YORK GUIDELINES FOR SURGERIES – 4/30/20


QUESTIONS ABOUT PPE – 4/30/20
Q: We are going to reopen when we get the ok, but having difficulty with getting PPE, of course, mostly masks.
We found kn95 but are only 95% for filtration efficiency and not 99.9% like an np5
Will we be safe if we where those and then put a regular level 2 or 3 over it, and then change that over mask every patient??

 
There are varying degrees of PPE needed based on what you are doing……
 
Stefanie Mozgai, BA, RN, CPM
Assistant Commissioner
Department of Health
Health Facility Survey & Field Operations
PO Box 367
Trenton, NJ 08625-0367

VIOLATIONS OF EXECUTIVE ORDERS – 4/30/20
I have been asked the question, so I am answering.
I hope no-one has to use this!
 
If you need to report a violation of an Executive Order- click here to report:

ICAR UPDATE – 4/30/20
Hi ICAR partners,
 
The  CDC LTC mini webinars  are now  live ! They are all published on the Key Strategies to Prepare for COVID-19 in Long-term Care Facilities (LTCFs)  web page  at the bottom under a “Webinar Series” section. These new webinars will be a great training tool/resource for frontline long-term care staff members.
 
Here are the direct links to each webinar:
 
 
Additionally, we would like to provide some additional   ICAR resources , including our Infection Control Auditing Guidance and our Caught Red-Handed exercise for proper hand hygiene.
Both documents can be accessed directly through the links below:
 
Jessica Arias, Bridget Farrell, Carol Genese, Melody Lee - NJDOH ICAR Team

BIPARTISAN GROUP OF SENATORS URGES REOPENING OF CERTAIN SECTORS OF ECONOMY INCLUDING ASCS FOR ELECTIVE PROCEDURES- 4/29/20 
Trenton –  Senate President Steve Sweeney and Senators Paul Sarlo, M. Teresa Ruiz, Steve Oroho, Declan O’Scanlon and Troy Singleton issued the following joint statement today offering Governor Murphy’s Economic Commission a plan to continue the public safety measures needed to counter the COVID-19 crisis and to offer some strategic steps to guide the reopening of New Jersey’s economy.

For more than a week, the bipartisan group of Senators have been consulting with the business community regarding strategies for reopening. The Senators stress the need for advance planning so it will bolster the state’s economic recovery, restore jobs and businesses, and rebuild the fiscal stability of state and local government while protecting the public’s health and safety.

“We implore the Governor’s commission to move swiftly with advancing a plan to support economic recovery for New Jersey. The Senate has been engaged in conversations with business owners and organizations who are experiencing this crisis and we have been communicating their needs with the Governor’s office and our legislative colleagues.

“Collectively, we need to make sure the communities that have struggled the most during this crisis have their issues carefully considered and addressed.
“We look forward to continuing this productive working dialogue with the Governor’s economic workgroup.

“With the Institute for Health Metrics and Evaluation projecting that New Jersey may be able start opening up on May 27, we do not have much time. We are fortunate that social distancing and stay at home orders have resulted in positive results. The Governor mentioned today, as he has for several days, that our trends continue to move in a positive direction.

“As we are developing plans for a full scale re-opening, we should consider how low-risk businesses and industries can safely reopen now, such as:
  • Construction;
  • Car sales;
  • Outdoor recreation like parks, golf courses;
  • Beach activities where social distancing can be sustained; and,
  • Elective Surgeries and other needed medical needs.

“These are consistent with New York and Pennsylvania where these activities are allowed:
  • Passive Recreation in the parks of Pennsylvania;
  • Passive Recreation in the parks of New York;
  • Golf in Pennsylvania as of May 1;
  • Golf in New York for individuals only;
  • Elective surgeries in New York; and,
  • Elective surgeries in Pennsylvania.”

QUESTION REGARDING ASCS AND TESTING- CLIA LICENSE- 4/29/20
Q: I have been asked if the rapid test is available to a facility or medical practice for staff and pts...does NJDOH require them to have a CLIA license to do so?

A: A CLIA certificate is required to perform any laboratory testing. Testing falls under a Certificate of Waiver or Certificate of Compliance.
Currently there are 3 FDA/EUA waived COVID19 tests available. They are POC molecular tests. At this time there are no serology waived tests. Moderate or High complexity tests require a NJ State Laboratory License. Please contact  joan.mikita@doh.nj.gov  for information.
 
The FDA/EUA website lists the approved tests available and their complexity.
 
Please contact me with any further questions.
 
Melanie Rinaldi
Manager of CLIA program
Clinical Lab Evaluator 3
Off: 609-406-6832
Fax 609-406-6827

PRIOR AUTHORIZATIONS DURING THE CRISIS - 4/29/20
You need to check with insurance carriers regarding prior authorizations for surgery considered elective during the crisis.
Some carriers are extending these for 90 days or more.
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Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com