All information contained in this email is confidential and not to be shared outside of the organization.
RWJUH COVID-19 Update
March 28, 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 update includes a brief summary of where RWJUH stands with the COVID-19 pandemic. 

Situational Update
 
RWJUH is managing 59 COVID-19 inpatients and is holding another 31 patients who are awaiting test results. Since early March, RWJUH has now managed a total of 104 COVID-19 patients.

Globally, over 615,000 people have tested positive for COVID-19. More than 100,000 of those cases are in the United States. As of today, New York and New Jersey continue to rank first and second among all states in the number of COVID-19 cases.

Executive Order: Suspension of Elective Surgeries

As part of the state’s effort to preserve the capacity of the health care system to respond to COVID-19, Governor Phil Murphy has signed an Executive Order directing the suspension of all elective surgeries and invasive procedures performed on adults that are scheduled to take place after 5:00 p.m. on Friday, March 27. The Governor’s Executive Order applies to all medical and dental operations that can be delayed without undue risk to the current or future health of the patient, as determined by the patient’s physician or dentist.

Kidney and Pancreas Transplantation Program Status

In an effort to maintain a safe environment for all of our patients and caregivers and to focus our resources on COVID-19 response, the Kidney and Pancreas Transplantation Program is temporarily inactive until further notice.

Personal Protective Equipment

We continue to have an adequate supply of Personal Protective Equipment in stock to care for our patients. As patient volume increases, it is vitally important for all of us to remain vigilant and conserve our PPE whenever possible.

Request and Guidance for Employee Self-Monitoring

In order to prevent the further spread of COVID-19, we are asking all RWJUH employees to self-monitor before coming to work each day. Self-monitoring involves checking yourself for the onset of any of the symptoms below that are not due to a pre-existing health condition (like asthma or emphysema):

• Temperature (100.0 degrees F or 38 degrees C or greater) or begin to feel warm
• Cough
• Shortness of breath (or difficulty breathing)
• Sore throat

Self-monitoring is an important tool to help people remember to recognize when they are becoming sick so they can self-isolate at home and avoid infecting others. If you self-monitor and believe you are positive for one or more of these symptoms, you should remain home and notify your supervisor. 

Once again, on behalf of myself and our entire Leadership Team, thank you for all of your hard work and support as we battle COVID-19. We are thankful and proud that you are part of our RWJUH Family. 

#RWJUHSTRONG
Supply Chain

Send your #RWJUHSTRONG photos to chris.hoenig@rwjbh.org and we'll feature them in the daily emails and on the new screen in the Courtyard!
RWJUH COVID Situational Update
As of 12:00 PM, RWJUH had 59 COVID-positive patients in the hospital. Tests on additional patients and potential discharges of positive patients were pending. 26 patients were in ICU level of care.

RWJUH has had 104 COVID 19-positive tests to date.

SBMU , RCU and 4 West are cohorting COVID-positive med/surg patients (IMCs on 4 West).

MICU , CCU & the former SICU-CORE are cohorting COVID-positive ICU patients.

Additional units are being prepared as part of the Surge Plan, to handle both med/surg and ICU patients.

As of 1:00 PM, the NJ Dept. of Health is reporting 11,124 COVID-positive patients in the state -- an increase of 2,289 from yesterday -- and 140 deaths . Of those, 808 positive patients are in Middlesex County, 781 are in Monmouth County, and 251 are in Somerset County.
UPDATED: RWJUH COVID-19 Treatment Protocols
The RWJUH Infectious Disease team has released updated treatment protocols for COVID-19 patients.

The protocols break down treatment plans for patients requiring ICU-level of care , requiring supplemental oxygen , and those with lower respiratory tract disease with risk factors for progression to severe disease.

Protocols will be updated and shared as evidence permits.

CLICK HERE to read the protocols.

Clinical Trials

Additionally, RWJUH is participating in several clinical trials involving the treatment of COVID-positive patients. As we get additional information, we will provide it below:

UPDATED: PPE & Isolation Guidelines
In accordance with CDC updates, guidance for the use of PPE and the isolation of COVID-positive patients has been updated. Among the changes:

COVID-Cohorted Units

  • Providers may use a single N95 mask for an extended/continuous period (risk of transmission from respirator or face mask during extended use is expected to be very low). Gloves and gowns should be changed for each patient.

  • Eye protection (both disposable and reusable) can be used for an extended/continuous period (Risk of transmission from eye protection and facemasks during extended use is expected to be very low).

Non-Cohorted Units

  • Surgical masks continue to be recommended, with the exception of high-risk, aerosolizing procedures (such as intubation) when N95 masks should be worn.

  • Disposable eye protection may be used for extended period as long as the integrity is intact.

ALL Units

  • Patient shall be given one face mask per day and asked to mask when clinicians are present in room as long as it does not interfere with a patient’s therapy. (i.e. during high flow treatment).

  • Parents of suspect and known COVID-19 children shall be masked in room when clinicians are present.

CLICK HERE for more details.

N95 Mask Decontamination Process

Ultraviolet (UV) light decontamination of two brands of N95 masks (3M and Kimberly Clarke Halyard duckbill) is available 24/7 , beginning Monday, March 30th at 2:00 PM .

RWJUH-NB staff, housestaff, and Medical Staff can bring their mask in a paper bag to the Bristol Myers Squibb Children’s Hospital (BMSCH) first floor conference room, in the BMSCH lobby area.

The mask will undergo a visual check, cleaning of straps, UV decontamination by our Tru-D machine using company guidelines, and a final check of integrity before the mask is returned to you. The Tru-D process takes 11 minutes , but please allow about 5-10 minutes before and after for processing your mask.

You can either wait in the area (please practice social distancing) or return approximately 30 minutes after you drop off your mask.

CLICK HERE for an FAQ on this process.

Thank you to our Environmental Services (EVS) team for their support of this program to keep our team safe.
Additional New Updates
  • We will no longer be isolating patients with cases of colonized MRSA or colonized VRE with no active infection. Patients with ACTIVE infections will continue to be placed on contact precautions. Nasal swabs for MRSA screening in critical care units will continue to be done.

  • RWJUH is evaluating access points into the hospital, and may reduce the number of entrances to help protect clinicians, staff and patients. This is consistent with many facilities throughout the region. Details will be announced as they are available.

  • Please do not go to the Command Center for supplies. N95 masks to use for FIT testing are available at the testing location.

  • The state has received a shipment of PPE from the Federal stockpile. The state is centralizing the collection and distribution of PPE, including these supplies.
  • Everyone's hard work and dedication to protecting our patients, as well as colleagues and hospital staff, has not gone unnoticed. CLICK HERE to watch a video message from RWJBarnabas Health President & CEO Barry H. Ostrowsky.

  • Please note, under CDC guidelines, you should NOT cover your N95 mask with a procedural earloop or surgical mask. It is currently unknown how that affects the mask's HEPA filtration.

  • Additionally, latest guidance from the CDC has changed masking requirements for treating COVID-positive patients. A surgical mask and face shield are adequate for non-aerosolizing treatments and assessments, with the patient wearing an earloop mask while you're in the room. N95 masks should still be work for patients undergoing aersolizing procedures and on high-flow oxygen.

  • A 24/7 Palliative Care COVID hotline has been established for network providers to call for support and guidance from MDs and APNs. The phone number is (973) 282-7233.

  • The RWJUH Emergency Department has received a device known as the AeroBox, which is designed to limit the risk of exposure to clinicians while intubating COVID-positive patients and PUIs. The acrylic box was designed by a Taiwanese physician, who shared the plans online. The Rutgers Biomedical Engineering Team used those plans to construct these boxes.

Surgical Masks Available - East Tower Rotunda
The universal masking policy is in effect.

Clinicians may pick up a surgical mask in the
East Tower Rotunda from 7a-7p daily.

Please present your ID. On off-hours, masks can be signed out at the Information Desk in the Courtyard.

Masks can be used on non-COVID units for an entire day and discarded when you leave the hospital. If the mask becomes wet or soiled , please discard and request a new mask.

For COVID-cohorted units , please follow PPE protocols when seeing patients.

CLICK HERE for the full policy.
How Can I Help?
As our hospital and Medical Staff continue working hard to provide the best care possible to our community, many are asking what they can do to help .

From PPE to food, and from technology to money, every little bit helps.

RWJUH and the RWJBarnabas Health system are streamlining the processes to vet, collection and distribute donations.

CLICK HERE for a link that you can share that includes ways the public can help, and contact information to connect them with those who can help.

Volunteering
As the number of COVID-positive patients (and clinicians) increases, we are working on plans to maintain our clinical staff to provide great care for our patients.

IF YOU WOULD BE INTERESTED IN VOLUNTEERING TO ROUND AND TAKE CALLS AT RWJUH (for COVID and/or non-COVID patients), please fill out the form below .
Additionally, RWJUH may look to clinicians to help set patients on ventilators should the surge in intubated patients outpace our Respiratory Therapy capacity. Clinicians may volunteer to assist with ventilating patients.

CLICK HERE for a brief overview on how to operate the models of ventilator used at RWJUH.

NOTE: We have not yet reached the level where we are calling on volunteers to begin rounding. This process is to allow us to build our contact lists, if the need to activate volunteers.
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.












REMINDER: Call For IP Approval BEFORE
Ordering COVID-19 Testing
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.
Daily Video Briefings
Every weekday 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 COVID-19@rwjbh.org and please CC Chris Hoenig and we will try to ensure they are also included in our daily Video Briefings.
Have You Tested Positive?
If you have tested positive for COVID-19 or are presently under quarantine , please contact the Medical Staff Office at RWJNBMA@rwjbh.org or (732) 937-8767 .

Providers having tested positive or 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.
Additional Information
  • The ACGME has established guidelines for reassigning residents/fellows in a pandemic, and Rutgers RWJMS has the flexibility to do so (i.e. reassign an endocrine fellow to general medicine service). Processes are in place to activate this plan if/when needed. CLICK HERE for more from the ACGME.

  • RWJUH is eliminating the ventilation portion for all Nuclear Medicine Lung scans for the foreseeable future. This is to protect our patients and staff alike, because of possible room contamination during the aerosol administration. If you believe your patient needs a lung scan, please obtain a Chest X-ray, PA and Lateral preferably, since aerosol ventilation is not being performed. Perfusion imaging alone, will often be diagnostic at ruling in or ruling out pulmonary embolism, particularly with a normal or near normal Chest X-ray. 

  • Additionally, due to a shortage in swabs and viral transport medium, RWJUH is only taking swabs from patients who are previously approved to be tested. Additionally, in the interest of conserving swabs and viral transport medium for patients requiring COVID-19 testing, please do not order any Respiratory Virus Panels (RVPs) until further notice.

  • RWJUH, along with the entire RWJBarnabas Health system, continue to manage our supplies, including PPE, medications, and equipment like ventilators. At this time, RWJUH continues to maintain an adequate stock of PPE. While our material team continues to source additional supplies and we are accepting donations, we are meeting staff needs at this time.

  • The triage tent outside the Emergency Department continues to work really well. ED leadership is evaluating expanding hours in the tent.

  • Updated guidance is available on the cleaning and reuse of goggles and face shields. CLICK HERE for details.

  • If you are concerned you may have been exposed to a COVID-19 positive patient, either in the community or in the hospital, please self-monitor your symptoms, including checking your temperature twice a day. Report any symptoms/temperature over 100.0 to RWJUH Corporate Care/Employee Health.

  • Blood donations continue to be needed. CLICK HERE to schedule an appointment with the RWJUH Blood Services team.

  • New guidelines are in place for the handling of COVID-positive decedents. All expirations of COVID-positive patients must be reported to the Medical Examiner's office and the NJ DOH Communicable Disease alert statement must be included, with COVID-19 written in as the infectious agent. CLICK HERE for the full guidelines.

  • ALL transfers into RWJUH must be reviewed and approved by the Service Chief. Any patients that have tested positive for, or suspected of having COVID-19 must be approved by the Chief Medical Officer or his designee.

  • ALL coordination with government officials must be handled through hospital leadership. If you have questions or suggestions for state leaders, please email Dr. Salwitz and he will coordinate with RWJUH leadership.

  • Additionally, all members of the Medical Staff are expected to protect confidential information, including the information contained in this email. DO NOT SHARE with the press or on social media. Given the volatility of the current environment, especially on social media, you should always use caution in what you post. If you are approached by the media for interviews, please reach out to the RWJUH Medical Staff Office to aid in clearing with the hospital Public Affairs team any hospital information that can be shared.

  • 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.

  • 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.
Additional Useful Resources