RWJUH COVID-19 Update
March 19, 2020
TO: All Members of the RWJUH Family
FROM: John J. Gantner, President and CEO, Robert Wood Johnson University Hospital
RE: RWJUH COVID-19 Update

Today’s Daily Update provides clarification and insight into our efforts to maintain a safe environment of care. Also included are operational updates.  

Return to Work After Exposure

This afternoon, RWJBH Corporate released a revised Return to Work after Exposure Policy. The policy is attached and should be read in its entirety. In summary, employees at all levels of exposure should continue to work as long as there is no evidence of even mild symptoms consistent with COVID-19. However, these staff members will be required to wear a surgical mask for 14-days post-exposure and must be screened prior to each shift.

Revised PPE (Masks) Policy

As more and more is learned about the novel coronavirus (COVID-19), the health care community is better able to establish practices and protocols that are effective in protecting both healthcare workers and their patients.  As a result of that growing knowledge and in consultation with the Hospital Epidemiologist, the Guideline for PPE (more specifically the appropriate use of masks) is being revised and will be re-issued shortly. As soon as finalized, we will immediately implement the changes.

Cleaning and Hygiene

We are deploying advanced technology and technique to maintain a clean and safe environment, as summarized below: 

  • Our Purell GOJO dispensers are electronically wired and centrally monitored by our hand hygiene team. The dispensers transmit information about the batteries and the amount of product available, as well as gel/soap usage statistics. Staff and Medical Staff should continue to be vigilant in their hand hygiene practices. 

  • Please contact Environmental Services at X8698 if you have any concern about the availability of Purell products or functionality of the dispensers.

  • Environmental Services and Patient Equipment utilize Black Light technology and Adenosine Triphosphate testing to check the cleanliness of high touch surfaces, patient care equipment, and the overall environment. We also utilize robots that emit ultraviolet light for terminal room disinfection.  

  • Recently, we initiated high-pressure steam cleaning in public high traffic areas.
 
Human Resources & Operations

  • If you have questions about PTO, child care or any other employment policies while we address this challenge, please call the RWJUH Human Resources Hotline at 732-937-4111. CLICK HERE for the Human Resources Employee Communications FAQs for additional information.  

  • RWJBH will be phasing out hot food service in The Dining Room as well as any food item that is not pre-packaged. We anticipate fully implementing this change by Saturday, March 21st at which time The Dining Room will be “grab & go”. This does not affect patient meals.

  • Beginning tomorrow, a Corporate Hotline manned 24/7 by RWJBH clinical professionals will be set up to answer questions about COVID-19. We will receive the Hotline phone number tomorrow and will include in my next update.  

#RWJUHStrong

We have launched the #RWJUHStrong campaign to recognize your extraordinary contributions and the amazing work you do every day. More to follow on the campaign but keep an eye on the new Courtyard video screen for some inspirational pics. 

For more information or if you have any questions about COVID-19: e-mail [email protected] .
 
Thank you again on behalf of our Leadership Team for all of your hard work and commitment to our patients and community during this public health crisis. I am consistently impressed by your resilience and dedication to working together as a team as we face this challenge together. 

CLICK HERE for the RWJBH Daily System Briefing.
RWJUH COVID Situational Update
As of 12:00 PM, RWJUH had 11 COVID-positive patients in the hospital. Tests on additional patients and potential discharges of positive patients were pending. At least six COVID 19-positive inpatient have recovered and been discharged.

RWJUH has had 21 COVID 19-positive tests to date.

As of 1:00 PM, the NJ Dept. of Health is reporting 742 COVID-positive patients in the state -- an increase of 318 from yesterday. Of those, 64 positive patients are in Middlesex County, 43 are in Monmouth County, and 21 are in Somerset County. A total of 18 counties in NJ have at least 1 positive patient.

CLICK HERE for the NJ DOH's county-by-county tracking page.
Are You Under Quarantine?
If you are presently under quarantine , please contact the Medical Staff Office at [email protected] or (732) 937-8767 .

Providers under quarantine should contact RWJUH Corporate Care/Employee Health for clearance to return to work. You may also need clearance from your employer.

Please provide documentation to the Medical Staff Office of your clearance to return to work.
Scientific Reviews
These links are provided solely for your consideration. The RWJUH Medical Staff Office is not providing these as recommendations for care of patients.








Additional New Updates
  • As New Jersey's premier academic medical center, RWJUH is always looking at the science of this evolving situation. Accordingly, the Infection Prevention team is assessing the possibility for updates in guidance regarding the use of masks for providers. Details will be provided as they are approved.

  • Additionally, the IP team continues to assess guidance regarding quarantining during this time. The latest guidance/policy change keeps RWJBH employees at work after an exposure as long as there is no evidence of even mild symptoms. Exposed staff will wear a surgical mask for 14 days. As of now, a return to work may be allowed after 7 days of improving respiratory symptoms IF the COVID-positive patient is afebrile for 72 hours, without the need for medication. CLICK HERE to read the RWJBH Return to Work Policy.

  • The RWJUH Visitation Policy has been updated -- NO visitors are now allowed in the Emergency Department. CLICK HERE to read the updated policy.

  • The hard-wiring of the RWJUH Action Plan continues. From a Medical Staff perspective, the ICU and Hospital Medicine teams have identified staffing models, if/when the need to ramp up arises.

  • The RWJUH OR has cancelled 330+ elective procedures to date. We continue to ask clinicians to cancel all purely elective procedures to ensure the hospital has adequate resources for this COVID-19 outbreak. CMS and ACS both advise to cancel all elective procedures.

  • The triage tent outside of the ED is up and running. A total of 39 patients were seen by the staff and two telemedicine robots yesterday (Wednesday, 3/18). See pictures below -- and keep an eye out for a story about the tent on News 12 NJ!
  • Dr. Sheraz Siddiqui, Chief of Hospital Medicine, was a guest on ABC Radio yesterday (Wednesday, 3/18). We will be sharing a link to listen to his interview.
COVID-19 Testing Guidance
--Reminder: NEW Phone Number For COVID-19 Testing Approval--

RWJUH is continuing to conduct a LIMITED number of COVID-19 tests in-house.


ALL REQUESTS FOR COVID-19 TESTING MUST GO THROUGH INFECTION PREVENTION .


The NEW phone number for testing approval is 732-947-9620 . NOTE: This is a new phone number, opened Tuesday. PLEASE DO NOT SHARE THIS NUMBER WITH ANYONE OUTSIDE OF RWJUH.

DO NOT CALL THE COVID-19 HOSPITALIST TEAM SEEKING ASSISTANCE IN GETTING TESTING APPROVED . The Hospitalist team is focused on caring for these patients and does not influence testing decisions.

For Infection Prevention questions, please use extensions 2480 / 4482 / 7552 / 4474 during regular business hours. The public may call 1-800-222-1222 for any COVID-19 questions.

Guidance on COVID-19 Testing For Patients Not Requiring Admission--

At the current time, due to a shortage in swabs and viral transport medium, RWJUH is only taking swabs from patients who need to be admitted to the hospital .

Additionally, in the interest of conserving viral transport medium for patients requiring COVID-19 testing, please do not order any Respiratory Virus Panels (RVPs) until further notice .
We're All In This Together
The nursing and support staff at RWJUH are doing exceptional work under these trying circumstances. They are here to help, but they face the same worries and concerns that we all do.

These are extraordinary times. You are doing extraordinary work. Please keep doing so, as we all work towards the same basic goals: provide the best possible care for our patients, while trying to keep them -- and ourselves -- safe .
Do NOT Enter SBMU
In addition to being a closed service, SBMU is a closed unit for the protection of our patients and providers.

Please do not enter SBMU unless asked or consulted by the COVID-19 Hospitalist team.

This is both for your protection - limiting your risk of exposure to the virus - and in the interest of high quality patient care , keeping the patients treatment limited to teams that are trained and gaining expertise in COVID-19.
Daily Video Briefings
Every morning, a video briefing by Dr. Jim Salwitz will be released, providing an update on COVID-19 activity at RWJUH and the implementation of the hospital's action plan.

BOOKMARK THIS PAGE and check daily for updates. New briefings will be posted at approximately 10:00 AM.

Have questions? Email [email protected] and please CC Chris Hoenig and we will try to ensure they are also included in our daily Video Briefings.
Blood Shortages
We have received notices from our blood suppliers regarding the tremendous strain COVID-19 has placed on blood supply . Recommendations from RWJBH’s Blood Management Program are as follows:

  • Strict adherence to the recommended transfusions triggers for RBCs:

  • 7g/dL for stable, non-bleeding patients (focus on entire clinical picture, symptoms not just a numbers)

  • 8g/dL for patient with cardiovascular disease

  • Single unit transfusion – RBCs and platelets (MUST reassess before ordering a second unit)

  • Surgical cases – anticipated blood loss ≥500cc implement cell saver with the requirement to spin down everything collected in reservoir and give back to the patient in order to reduce the need for banked blood

  • Minimize serial lab draws – focus on draws that are necessary (keep the blood in the patient)

  • ICU/CTICU and CCU – ensure utilization of VAMP (Venous Arterial blood Management Protection) systems to re-infuse excess blood not needed when drawing blood sample for testing

--Blood Donations Accepted-- 

Your help to encourage healthy people to donate blood and platelets is requested at this time. Our RWJUH Blood Services staff is working very hard to continue to provide services throughout this unprecedented time. Our goal is to maintain a safe and adequate supply for our patients in need!

Please have interested and potential donors access our appointment portal at rwjuhdonorclub.org or call 732-235-8100 x221 .
Updated N95/All Mask Information
--FIT Testing Restrictions--

FIT testing remains limited to areas that will be treating COVID-19 patients and PUIs. When testing is opened up to a wider group, we will let you know.

--Proper Use of Masks (Which Sometimes Means NOT Wearing A Mask) Are Important To Preventing Infection Spread--

Proper use of masks includes :

  • Put the mask on when you're donning PPE to enter a room, and fully remove it while doffing after exiting;

  • Do NOT leave a mask dangling around your neck;

  • You do NOT need to wear a mask while walking on floors or around our campus. As we are carefully monitoring mask supply, unnecessary use of masks not only depletes supplies, but spreads fear.
Additional Information
  • Please ensure your ID is visible at all times. RWJUH continues to evaluate campus entrance points to ensure the safety of our patients, clinicians and staff.

  • Leaders at Bristol-Myers Squibb Children's Hospital continue finalizing plans to cohort all pediatric patients with respiratory illness, including COVID 19-positive patients and PUIs;

  • There are no special laundry handling guidelines for COVID-19 -- standard washing and use of disinfectants on surfaces will kill the virus. While you may choose to not wear your white coat, standard precautions will help prevent the spread of the virus;

  • The new digital screen in the Courtyard is now live and includes information on COVID-19;

  • As we continue our efforts to restrict the number of people entering our facilities, a temporary ban is being put in place on flower deliveries to patients;

  • The Federal government announced today that CMS will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the country. Beneficiaries will be able to receive telehealth services in any healthcare facility, including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes. Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. CMS is waiving certain HIPAA requirements for telehealth services during this Public Health Emergency, allowing the use of platforms like Facetime on cellphones.
Additional Useful Resources