Latest / The SHEA Podcast / COVID-19 Social Distancing For Eating, Break Rooms, Cafeterias, Lectures & Beyond, 12/10

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COVID-19 Social Distancing For Eating, Break Rooms, Cafeterias, Lectures & Beyond, 12/10 · The SHEA Podcast

• 0:09
  SPEAKER_02: Welcome to the Rapid Response Podcast brought to you by Society of Healthcare Epidemiology of America, promoting the prevention of healthcare associated infections, antibiotics resistance, and seeking to advance the field of healthcare epidemiology and antimicrobial stewardship.
• 0:25
  SPEAKER_02: I am Dr.
• 0:26
  SPEAKER_02: Wali Jaweed, hospital epidemiologist from Mount Sinai downtown, and I will serve as your moderator.
• 0:32
  SPEAKER_02: The discussion on this podcast does not reflect Shay's perspective but facilitates communication of multiple perspectives and experiences as we go through this challenging time.
• 0:44
  SPEAKER_02: Shay is excited to launch this episode of the podcast COVID-19 updates, What We Know Now.
• 0:50
  SPEAKER_02: Today's discussion will focus on social distancing for eating, break rooms, cafeterias, lectures, and beyond.
• 0:57
  SPEAKER_02: Our speakers today are Dr.
• 0:59
  SPEAKER_02: Michael Colampus, hospital epidemiologist at Wrigham and Women's Hospital, and Dr.
• 1:05
  SPEAKER_02: Tara Palmore, hospital epidemiologist at National Institute of Health.
• 1:10
  SPEAKER_02: Thank you for joining us today.
• 1:11
  SPEAKER_02: Before we start our discussion, I would like to turn to Dr.
• 1:15
  SPEAKER_02: Carnahan to get us started with brief news and guidance updates for this week.
• 1:21
  SPEAKER_00: As of December 9, 2020, there have been 67,530,912 confirmed cases of COVID-19, including 1,545,140 deaths reported to the World Health Organization.
• 1:35
  SPEAKER_00: News this week is all about COVID vaccines.
• 1:38
  SPEAKER_00: Vaccination began in the UK yesterday, and the first two people vaccinated were 90-year-old Margaret Keenan and 81-year-old William Shakespeare.
• 1:46
  SPEAKER_00: In comments made by Dr.
• 1:47
  SPEAKER_00: Stephen Hahn, Commissioner of Food Information on December 4th to the National Academy of Medicine Town Hall, Dr.
• 1:52
  SPEAKER_00: Hahn stated that the FDA is facilitating expedited COVID-19 vaccine development.
• 1:57
  SPEAKER_00: Two manufacturers have submitted emergency use authorization requests, and others are in the pipeline.
• 2:02
  SPEAKER_00: Speedy but rigorous transparency will be assured via publicly available guidelines for manufacturers and by submission to the vaccines and related biological products advisory committees.
• 2:12
  SPEAKER_00: This committee is composed of external experts providing non-binding recommendations to the FDA.
• 2:17
  SPEAKER_00: There will be two open meetings scheduled to discuss two COVID-19 vaccines.
• 2:21
  SPEAKER_00: December 10th will be Pfizer Science Tech, and December 17th will be Moderna.
• 2:26
  SPEAKER_00: FDA will not authorize or approve any COVID-19 vaccine or therapeutic before it has met the agency's rigorous standards for safety and effectiveness.
• 2:34
  SPEAKER_00: Decisions to authorize or approve any COVID-19 vaccine or therapeutic will be made by the dedicated career staff at the Food and Drugs Administration for their gold standard review processes, and science and data will guide decisions, and FDA will not permit any pressure from anybody to change that.
• 2:48
  SPEAKER_00: Dr.
• 2:49
  SPEAKER_00: Hahn stated that the FDA will fight for science.
• 2:51
  SPEAKER_00: FDA will fight for the scientific integrity of the agencies and will put the interests of the American people ahead of anything else.
• 3:21
  SPEAKER_00: Suggest a favorable safety profile with no specific safety concerns.
• 3:25
  SPEAKER_00: The most common solicited adverse reactions were injection site reactions, fatigue, headache, muscle pain, chills, joint pain, fever.
• 3:32
  SPEAKER_00: Severe adverse reactions occurring in 0 to 4.6% of participants were more frequent after dose 2 than after dose 1, and were generally less frequent in participants over 55 years of age as compared to younger participants.
• 3:45
  SPEAKER_00: An article published in the Numen Journal of Medicine on December 2nd on repurposed antimoral drugs for COVID-19, an interim World Health Organization solidarity trial results evaluated when desivere hydroxychloroquine and interferon beta 1 alpha in patients calculated with coronavirus disease.
• 4:03
  SPEAKER_00: In patients with COVID-19 were randomly assigned equally between one of the trial drug regimens that was locally available and a control group.
• 4:10
  SPEAKER_00: The intention to treat primary analyses examined in hospital mortality and the four-pair-wise comparisons of each trial drug and its control.
• 4:17
  SPEAKER_00: Rate ratios for deaths were calculated with stratification according to age and status regarding mechanical ventilation and trial entry.
• 4:29
  SPEAKER_00: 2,750 were time to receive and severe 954 trial drugs for core points, 1,411 to low tenivore, 2,063 to interferon, and 4,088 to no trial drugs.
• 4:42
  SPEAKER_00: No trauma definitely reduced mortality overall, or in any subgroup or reduced initiation of ventilation or hospitalization duration.
• 4:50
  SPEAKER_00: Finally, the advisory committee on immunization practices, interim recommendation for allocating initial supplies of COVID-19 vaccines were published in the Morbidity and Mortality Weekly report on December 3rd.
• 5:00
  SPEAKER_00: The Advisory Committee on Immunization Practices convened on December 1st, 2020, in advance of the completion of FDA's review of the emergency use authorization applications to provide interim guidance.
• 5:11
  SPEAKER_00: The ACIP recommended that when a COVID-19 vaccine is authorized by FDA and recommended by ACIP, both healthcare personnel and residents of long-term care facilities be offered vaccinations in the initial phase of the COVID-19 vaccination program.
• 5:24
  SPEAKER_00: And that's the news for this week.
• 5:27
  SPEAKER_02: Thank you, Jennifer.
• 5:28
  SPEAKER_02: I'll now move into the discussion with Dr.
• 5:31
  SPEAKER_02: Klompas and Dr.
• 5:32
  SPEAKER_02: Palmore.
• 5:34
  SPEAKER_02: First question for Dr.
• 5:35
  SPEAKER_02: Klompas.
• 5:36
  SPEAKER_02: What do we know about outbreaks in hospitals and how they happen?
• 5:42
  SPEAKER_01: Thank you for that question.
• 5:43
  SPEAKER_01: I think what we do know is that there are more and more of them occurring nationwide.
• 5:47
  SPEAKER_01: Many of them have been attributed to employees passing infection one to the other, often in social settings such as break rooms or workrooms where employees might be getting together without wearing a mask, either because they're eating or they're socializing or because they feel like somehow that they're protected in those environments because they're not patient-facing.
• 6:04
  SPEAKER_01: So many, many small employee-based clusters have been reported on that basis.
• 6:08
  SPEAKER_01: A smaller number have been reported that has spilled over into patients, and those go in two flavors, where employees who are either recently infected from the community then pass it on to a patient, or occasionally a patient who is incubating at the time of admission and therefore has a misdiagnosis, who then is able to pass it on to employees.
• 6:26
  SPEAKER_02: Dr.
• 6:26
  SPEAKER_02: Palmore, what are your thoughts on this?
• 6:29
  SPEAKER_03: Yes, I concur with what Dr.
• 6:30
  SPEAKER_03: Kampus said.
• 6:31
  SPEAKER_03: I think that there's a perception by employees that their real threat from COVID-19 is patients, that they are at much greater risk of acquiring COVID-19 from patients than they are at acquiring infection from each other.
• 6:44
  SPEAKER_03: So they're very comfortable taking their masks off in these spaces, in break rooms and outside of work with each other, whereas they would not consider, hopefully not consider doing that around patients.
• 6:56
  SPEAKER_03: I think another reason for outbreaks in hospitals and perhaps transmission to patients is that employees might show, especially as the pandemic has progressed and there's pandemic fatigue, low self-awareness of their own potential COVID symptoms.
• 7:11
  SPEAKER_03: And I think throughout the pandemic, we have seen hospital employees attribute their symptoms to allergies, in quotes.
• 7:18
  SPEAKER_03: In fact, I can tell you just anecdotally that I've had two clinical staff members just this week diagnosed with COVID after getting themselves tested, even though they actually believe their symptoms were due to allergies to the Christmas trees they had just put up.
• 7:31
  SPEAKER_03: Now, to their credit, they still got themselves tested.
• 7:34
  SPEAKER_03: They did not dismiss their symptoms, but there may be others who really did dismiss their symptoms as Christmas tree allergies.
• 7:40
  SPEAKER_03: And that's just an example.
• 7:42
  SPEAKER_01: We've seen a similar phenomenon as well, people dismissing their symptoms as allergies or quote unquote a cold or asthma exacerbation, and in some cases delaying getting tested or not getting tested at all.
• 7:52
  SPEAKER_01: So yeah, that is certainly a concern.
• 7:55
  SPEAKER_02: Yeah, I actually I would totally agree with both of your statements.
• 7:58
  SPEAKER_02: We actually have seen and continue to see exact same scenarios here.
• 8:02
  SPEAKER_02: Some getting tested even though they didn't think it was relevant.
• 8:06
  SPEAKER_02: I think the biggest issue occurs when even after getting tested, they continue to work.
• 8:10
  SPEAKER_02: I think since the beginning of this outbreak, there has been some challenges in how people understand this illness.
• 8:17
  SPEAKER_02: And now us knowing that this can even get transmitted without having any symptoms, I think our staff don't realize that even with minimal symptoms, we might be transmitting this illness to everyone.
• 8:28
  SPEAKER_02: I think that has been our message that actually consider everyone around you as infected and continue to wear your mask, social distance, hand hygiene, continue to do everything, but consider everybody around you as infected.
• 8:41
  SPEAKER_02: But all those points are extremely relevant.
• 8:43
  SPEAKER_02: So, Dr.
• 8:44
  SPEAKER_02: Palmore, how are you managing staff spaces like break rooms for eating to keep people safe?
• 8:51
  SPEAKER_03: Well, the way we've managed them since early on is probably the way that many other hospitals have done so, with signage and removal of chairs, spacing out of tables and chairs.
• 9:02
  SPEAKER_03: And then people bring in more chairs.
• 9:04
  SPEAKER_03: So then we remove the chairs again.
• 9:06
  SPEAKER_03: And another anecdote, I discovered in recently interviewing a positive case in an employee that when our employees apparently want to evade our break room limits, what they have been doing is taking their lunches outside and gathering in groups in one employee's car.
• 9:24
  SPEAKER_03: So for example, if a break room has a limit of three people because of the size of the break room and they want to gather in a group of four, they take their lunches outside, gathered in a group in one employee's car, all four of them, with the engine on, the windows up, and the doors closed.
• 9:39
  SPEAKER_03: I discovered this in the contact tracing, and apparently it's not an isolated incident.
• 9:44
  SPEAKER_03: So people who are determined to evade break room and other safety measures to gather in groups will find ways to do so away from the gaze of infection control.
• 9:54
  SPEAKER_01: Gosh, you know, I can't top that up.
• 9:56
  SPEAKER_01: That is absolutely stunning that people are so committed to their socializations, even in an unsafe fashion, that they'll go to that kind of extent.
• 10:03
  SPEAKER_01: But I think it does speak to the critical necessity of trying to bring our staff members on board with the way we think about risk perception and the necessity of safe behaviors.
• 10:12
  SPEAKER_01: So that a lot of I think parallel work, in addition to decreasing the density of chairs and workstations inside of our workrooms, making sure they have good ventilation, making sure people know about spacing, good signage, et cetera, is education.
• 10:23
  SPEAKER_01: And so we spend a lot of time with town forums trying to talk through what we understand about the risk factors for transmission both inside and outside the hospital with the hope that it will hit home and that people will manage their safety accordingly.
• 10:36
  SPEAKER_02: We actually have had very similar scenarios in staff who may not be understanding the reasons of not being able to eat together in the break rooms.
• 10:46
  SPEAKER_02: In fact, I have been thinking about exactly what our message is, which actually is telling them to not to socialize.
• 10:52
  SPEAKER_02: Although for decades, that's kind of been the behavior or that kind of been what is the norm for groups and teams to work together, to eat together, to do everything together.
• 11:02
  SPEAKER_02: It's really the family feeling that they get together.
• 11:05
  SPEAKER_02: And what now we're telling them is to actually not socialize.
• 11:08
  SPEAKER_02: And I think that's kind of really where our messaging now has become.
• 11:12
  SPEAKER_02: What we did for our break rooms is pretty much made a rule that one break room, if we identify it as an eating area, that's only for eating.
• 11:21
  SPEAKER_02: You cannot go in there to socialize.
• 11:23
  SPEAKER_02: And then there are other areas that you can go to socialize, but you cannot eat.
• 11:27
  SPEAKER_02: And that has been helpful.
• 11:28
  SPEAKER_02: But we have actually seen chairs coming back into the break rooms that we took out and all that.
• 11:33
  SPEAKER_02: So it's a constant reminder, right?
• 11:35
  SPEAKER_02: I think it's interesting to notice that everybody is in the same situation.
• 11:39
  SPEAKER_02: I think we just need to continue to massage.
• 11:42
  SPEAKER_02: Dr.
• 11:42
  SPEAKER_02: Kampas, what about the other spaces such as the workrooms and cafeteria?
• 11:48
  SPEAKER_01: So workrooms are kind of a riff on break rooms, in that it's another space where people get together away from patients and therefore perceive themselves to be in a safer area.
• 11:56
  SPEAKER_01: One of the realities, as we know, of contemporary medicine is that, particularly for residents, fellows, etc., that they spend a great deal of time on the computer, which are located inside of workrooms by and large.
• 12:06
  SPEAKER_01: And so they might be in there for hours and hours at a time.
• 12:08
  SPEAKER_01: You alluded to the stance that people who work together come to see one another as family.
• 12:13
  SPEAKER_01: And just as when we're with our families, we tend not to wear masks and we eat together.
• 12:18
  SPEAKER_01: People, I think, subconsciously project that upon their closest peers at work.
• 12:21
  SPEAKER_01: And I think that's particularly true of medical residents or people in the same fellowship program together or nurses who work together in the same unit all the time, and therefore have that sort of this false sense of security in the sense that they're in a protected bubble and therefore will congregate, eat together, work together at close quarters without masking.
• 12:38
  SPEAKER_01: So what we have done is try to do some of the same things we mentioned with break rooms, is decrease the density of them to take out workstations, take out chairs, put up some additional barriers between stations, some flexiglass barriers, try to focus in again on the issue of education.
• 12:51
  SPEAKER_01: We have to create new workrooms in order to be able to accommodate the decreased density in each workroom.
• 12:56
  SPEAKER_01: And what we've had less success doing, but I think we need to do, and I think you were hinting at this, is try to convey to people that they have to think about different ways of working.
• 13:04
  SPEAKER_01: A team does not necessarily have to all be in the same room at the same time in order to function effectively as a team.
• 13:10
  SPEAKER_01: Can they not spread out and do their work in separate locations?
• 13:13
  SPEAKER_01: Can they not communicate via telephone, text message, Zoom, et cetera, rather than always having to continue to be in the same space together?
• 13:19
  SPEAKER_01: Those are some of the measures I think we've been implementing, contemplating, discussing.
• 13:23
  SPEAKER_02: Dr.
• 13:24
  SPEAKER_02: Balmore, any thoughts?
• 13:26
  SPEAKER_03: Yes, I agree with all that.
• 13:27
  SPEAKER_03: I think a couple of other additions would be, you know, we are used to having an attending physician sit next to a fellow or resident and review labs or review films on the computer, and that's not such a good idea these days.
• 13:42
  SPEAKER_03: So there's another adaptation.
• 13:44
  SPEAKER_03: We can do that by Zoom, we can do that remotely.
• 13:46
  SPEAKER_03: Another factor in workrooms is that you have house staff, residents or fellows, all eating.
• 13:52
  SPEAKER_03: They may be facing in different directions on workstations, but they have their masks down eating very often while they're working.
• 13:58
  SPEAKER_03: So staggering their eating might help prevent multiple unmasked exposures, even though they do have to eat, often can't take a break to do that while they're working.
• 14:07
  SPEAKER_03: You mentioned cafeterias, I think.
• 14:09
  SPEAKER_02: Yes.
• 14:10
  SPEAKER_03: So cafeterias are wide open spaces, and there's certainly the potential for significant distancing in cafeterias, but it has to be well planned so that they don't become like indoor restaurants.
• 14:21
  SPEAKER_03: So like break rooms, removing tables and chairs to limit density and putting up signage about not moving chairs, requiring masks before and after meals, I think are ways to make cafeterias safer.
• 14:34
  SPEAKER_02: Those are very similar to our processes as well.
• 14:36
  SPEAKER_02: I'll talk a little bit about cafeterias, and that's most of our cafeterias we actually either limited or eliminated eating in the cafeterias, but the cafeterias which have halls or rooms that can accommodate.
• 14:49
  SPEAKER_02: We have placed chairs six feet apart and in directions that are away from each other, and then also instruct the staff members to actually be cognizant, to be quick or to use very little time unmasked.
• 15:02
  SPEAKER_02: So if they are having conversation or they are talking on the phone or doing anything else, they should put their mask back on.
• 15:09
  SPEAKER_02: So it's a constant struggle to continue to inform our staff on that.
• 15:14
  SPEAKER_02: In regards to the resident workrooms and others, one thing we did was to actually also engage the program directors for our residents to make sure that they are also engaged and involved and they help in rounding in those areas too, just because infection prevention alone or one group alone cannot manage all that.
• 15:33
  SPEAKER_02: It's a very big project to continue to monitor all these things.
• 15:38
  SPEAKER_02: Dr.
• 15:38
  SPEAKER_02: Palmore, tell me about educational conferences and how are those being managed?
• 15:44
  SPEAKER_03: Essentially, all of our educational conferences have been converted to virtual conferences.
• 15:50
  SPEAKER_03: So a very few rounds that involve fewer than 10 people may take place in a large conference room physically distanced with no food or drink allowed.
• 16:02
  SPEAKER_03: So people can't have a cup of coffee, for instance.
• 16:04
  SPEAKER_03: But almost everything has been converted to virtual.
• 16:08
  SPEAKER_02: How about you, Dr.
• 16:09
  SPEAKER_02: Klompas?
• 16:10
  SPEAKER_01: Yeah, we also have a requirement that all educational conferences need to be virtual.
• 16:14
  SPEAKER_01: And the issue, as we know, is that education has often been tied to eating.
• 16:17
  SPEAKER_01: And so having it in person is a risk proposition.
• 16:20
  SPEAKER_01: So completely agree.
• 16:22
  SPEAKER_02: We actually also did the same thing.
• 16:24
  SPEAKER_02: All educational conferences have been pretty much virtual.
• 16:27
  SPEAKER_02: Actually, that did help us away some of the lecture rooms to make it available for our staff to eat in a socially distant manner.
• 16:34
  SPEAKER_02: So that has helped.
• 16:36
  SPEAKER_01: The one caution with it is that if you take away that mechanism or that location, that opportunity for eating, you do worry that people will then go back to their workrooms or their break rooms and eat and perhaps they do that in an unsafe fashion.
• 16:46
  SPEAKER_01: There has to be sort of a parallel effort to make sure that those other locations have appropriate spacing and safe measures in place.
• 16:51
  SPEAKER_01: Otherwise, you're simply squeezing the balloon.
• 16:53
  SPEAKER_02: That's a good analogy.
• 16:55
  SPEAKER_02: We cannot do the squeezing the balloon process.
• 16:57
  SPEAKER_02: We really need to be very, very cognizant.
• 16:59
  SPEAKER_02: So it's a deliberative process.
• 17:01
  SPEAKER_02: This cannot really be just, oh, you can use this room or that.
• 17:04
  SPEAKER_02: It has to be very deliberate.
• 17:06
  SPEAKER_02: Totally agree.
• 17:07
  SPEAKER_02: So, Dr.
• 17:07
  SPEAKER_02: Klumbus, how are you managing residents in your facilities during the pandemic?
• 17:12
  SPEAKER_01: Yeah, so we spoke about this phenomenon that of residents seeing one another as family members and therefore perceiving one another to be safe environments or safe islands where they can let down their guard.
• 17:21
  SPEAKER_01: So part of it is it comes back to the issues we spoke about before about trying to set up workrooms in a safe fashion, trying to have residents be thoughtful about how they conduct rounds and how many people participate in rounds, not crowding five people around the bed of a patient in a small room at the same time for an extended teaching session or a clinical analysis.
• 17:38
  SPEAKER_01: The other phenomenon is that residents often relate to one another outside of work as well.
• 17:42
  SPEAKER_01: And I remember one striking episode a month or two ago where we heard about a resident who pulled together 10 other peers and they put on a sort of a spectacular brunch for them in his apartment, which they all enjoyed together without masking, et cetera.
• 17:53
  SPEAKER_01: And then lo and behold, the resident who organized it turned out to be positive at that time.
• 17:57
  SPEAKER_01: And luckily, that particular event did not lead to any resident transmissions, but certainly sort of waved a red flag about some risk perception that was taking place amongst our residents.
• 18:07
  SPEAKER_01: The other factor is that many residents live together in addition to socializing together.
• 18:10
  SPEAKER_01: And so we know that households are a high risk setting for transmission.
• 18:14
  SPEAKER_01: And so being cognizant of that potential avenue as well as which transmission might be taking place.
• 18:19
  SPEAKER_01: So this has been working together with our residency leaders and with our chief medical residents again to try to put forward these ideas around risk and safety, both inside and outside the hospital.
• 18:29
  SPEAKER_01: The parallel piece of work, I think, on this front has been increasing the ease and availability of testing for residents, certainly for those who have any kind of symptoms or any kind of exposure.
• 18:39
  SPEAKER_01: We're at the point now where we have on-site free testing available on demand for really any employee, including our residents, at any time that they wish.
• 18:47
  SPEAKER_01: And that I think has helped to alleviate some of the concern amongst residents that they might be passing the virus one to another because of the nature of their working circumstances or their living circumstances, even if they're trying their very best to be safe.
• 18:59
  SPEAKER_01: The nature of the work and the nature of their living situation sometimes forces them into scenarios where they don't feel they can be perfectly safe.
• 19:06
  SPEAKER_02: I totally agree that I think it's an ongoing effort.
• 19:08
  SPEAKER_02: So, Dr.
• 19:09
  SPEAKER_02: Paul Morrill, any considerations for how staff are getting to and from the hospital?
• 19:15
  SPEAKER_02: You've already talked a little bit about the using the car as a lunch area.
• 19:20
  SPEAKER_02: So, but have you done anything specific?
• 19:23
  SPEAKER_03: You know, at our facility, and in particular, this may apply differently to different regions and metropolitan areas of the country.
• 19:31
  SPEAKER_03: The staff at highest risk of acquiring COVID are generally those who are carpooling or taking public transportation.
• 19:38
  SPEAKER_03: I think there's an overlay of risk factors.
• 19:40
  SPEAKER_03: And so carpooling is clearly very high risk if it's done by members of different households.
• 19:46
  SPEAKER_03: I think that's obvious.
• 19:47
  SPEAKER_03: Public transportation, the risk of taking subways or buses depends in part on the density of use of public transportation and adherence to mask wearing in a given metropolitan area or even who's in the subway or the bus at the time that you are on cleaning, on airflow, a lot of the factors.
• 20:05
  SPEAKER_03: So that's how staff get to and from our hospital when we do contact tracing for infected staff.
• 20:11
  SPEAKER_03: We always ask how they get to and from the hospital.
• 20:14
  SPEAKER_03: But we haven't made any special provisions for staff.
• 20:17
  SPEAKER_03: There are tens of thousands of people who work at the NIH and about 4,000 who have patient contact.
• 20:23
  SPEAKER_03: Not in an area where we really had an ability to intervene.
• 20:27
  SPEAKER_02: In New York City, where I work, I think we do have a lot more utilization of public transport.
• 20:32
  SPEAKER_02: So our challenges are slightly different.
• 20:34
  SPEAKER_02: We've been giving them more instructions on how to stay safe using public transport.
• 20:40
  SPEAKER_02: But there are people who still do carpooling and all, and we face the same challenges.
• 20:44
  SPEAKER_02: And I guess we try to do the same message that hey, it's not safe to be in the same car at the same time.
• 20:50
  SPEAKER_02: There's specific risks, including if you have the windows closed and in winter specifically, you'll have the windows closed.
• 20:57
  SPEAKER_02: You have recirculating air in the car.
• 20:59
  SPEAKER_02: There's very high-risk interaction.
• 21:01
  SPEAKER_02: So I think that still remains a very high-risk activity.
• 21:04
  SPEAKER_02: So moving on, Dr.
• 21:06
  SPEAKER_02: Columbus, how are you monitoring this within all the different areas in your hospital?
• 21:12
  SPEAKER_01: What we've tried to imbue is a sense that all our leaders are responsible for helping to convey safety.
• 21:18
  SPEAKER_01: So the branding of our approach to COVID at the hospital is called our safe care commitment.
• 21:22
  SPEAKER_01: And we have both dedicated safe care commitment staff who wear a special teel-colored vest that says safe care commitment, and have these giant buttons that say it'sn't the effect of keeping each other safe.
• 21:32
  SPEAKER_01: And they roam the hospital looking for masking, eye protection, safe eating, density of workrooms and break rooms.
• 21:39
  SPEAKER_01: And then we also have leader rounds where some of our senior administrators leaders, some of our senior clinical leaders will don that same vest andor button and go on rounds themselves to target the area of the hospital to basically check out what's going on and in a sort of collaborative and collegial kind of fashion try to remind people about what's safe.
• 21:56
  SPEAKER_02: That's brilliant.
• 21:57
  SPEAKER_02: Dr.
• 21:57
  SPEAKER_02: Palmore, any thing you guys are doing?
• 22:00
  SPEAKER_02: Different?
• 22:01
  SPEAKER_03: I think we have a similar approach, but without the cool branding.
• 22:05
  SPEAKER_03: We have the leadership of a number of disciplines involved in safety making rounds and speaking with staff, speaking with patients routinely throughout the week.
• 22:15
  SPEAKER_02: I would agree.
• 22:16
  SPEAKER_02: We also have a very similar approach, but no branding.
• 22:19
  SPEAKER_02: But I think we're gonna steal the branding from you.
• 22:22
  SPEAKER_02: But it's a great idea to actually have more commitment from the leadership.
• 22:25
  SPEAKER_02: I think one group cannot alone cover all the different areas we work in.
• 22:31
  SPEAKER_02: And our approach needs to be all across each and every area where people can congregate and show that they are safe.
• 22:37
  SPEAKER_02: Dr.
• 22:38
  SPEAKER_02: Palmore, how are you handling the analogous behaviors outside the hospital?
• 22:44
  SPEAKER_03: Well, one of the things, just to pick up on something Dr.
• 22:46
  SPEAKER_03: Klumpus mentioned earlier, to me, one of the most interesting and frustrating phenomena is when healthcare colleagues become extremely anxious about, for example, being around an asymptomatic patient who recovered from COVID weeks ago and having that patient under their care out of isolation because they have met criteria for discontinuing isolation.
• 23:07
  SPEAKER_03: Yet they have no qualms about gathering in groups unmasked for meals or brunch or drinks with colleagues.
• 23:14
  SPEAKER_03: It really shows a misplaced understanding of risk.
• 23:17
  SPEAKER_03: So we do a lot of education of staff in all disciplines that we can reach.
• 23:22
  SPEAKER_03: As Dr.
• 23:23
  SPEAKER_03: Columbus said, you can't just educate once and leave it at that.
• 23:27
  SPEAKER_03: You can't take the chairs out of the break rooms once and leave it at that.
• 23:30
  SPEAKER_03: You have to come back and educate over and over again about analogous behaviors outside of the hospital.
• 23:36
  SPEAKER_03: You have to take the chairs out of the break room repeatedly, especially with pandemic fatigue.
• 23:41
  SPEAKER_03: People stop wearing face shields.
• 23:43
  SPEAKER_03: You have to remind them to wear face shields.
• 23:46
  SPEAKER_03: People will gather for Thanksgiving.
• 23:48
  SPEAKER_03: We educate them about not gathering for Thanksgiving.
• 23:50
  SPEAKER_03: They'll gather again for the winter holidays.
• 23:52
  SPEAKER_03: We'll remind them again.
• 23:54
  SPEAKER_03: We just have to continue messaging, delivering these messages about behaviors outside of the hospital that put them at risk for bringing COVID into the hospital.
• 24:03
  SPEAKER_02: Dr.
• 24:03
  SPEAKER_02: Klompos, what are your thoughts on this?
• 24:06
  SPEAKER_01: I echo all the words of Dr.
• 24:08
  SPEAKER_01: Palmore.
• 24:08
  SPEAKER_01: I think we're trying to make people appreciate that there are much greater risk of getting COVID outside the hospital compared to inside the hospital.
• 24:15
  SPEAKER_01: I think we've seen that again and again with analyses of healthcare worker infections that most are associated with other household contacts or outside of hospital activities, and only a minority associated with in-hospital-based transmission.
• 24:25
  SPEAKER_01: So helping people to appreciate that's where the true risk lies, and therefore that's where the safe practices need to be doubled up in order to protect themselves and protect the rest of the community.
• 24:34
  SPEAKER_02: Totally agree with both of your statements.
• 24:36
  SPEAKER_02: I think the risk outside the hospital still remains higher than inside the hospital, and the efforts needs to be focused on making people understand that congregation and everything else is outside the hospital, is very, very, very dangerous, spreading the illness to them and their loved ones.
• 24:51
  SPEAKER_02: That has been my message here as well.
• 24:53
  SPEAKER_02: Before Thanksgiving, I was telling everybody to cancel their Thanksgiving meetings.
• 24:56
  SPEAKER_02: I would never imagine myself saying that.
• 24:59
  SPEAKER_02: But that's the way we have to be messaging it and continue to message it.
• 25:03
  SPEAKER_02: Similar question for Dr.
• 25:05
  SPEAKER_02: Klumpus: what have you learned about staff behaviors during Thanksgiving holiday and how will you apply for the December and January holidays?
• 25:13
  SPEAKER_01: I think what we see nationally was mirrored locally, which was that in practice, a lot of people did end up breaking out of their bubbles and associating with additional people and traveling.
• 25:22
  SPEAKER_01: I mentioned before that we do offer free on-site testing on demand for any employee.
• 25:26
  SPEAKER_01: So on the Tuesday before Thanksgiving, we had no fewer than 1,502 employees that chose to get tested.
• 25:32
  SPEAKER_01: After that, I sort of suddenly scratched my head and said, you know, how should I think about that?
• 25:36
  SPEAKER_01: I mean, on the one hand, it's terrible.
• 25:37
  SPEAKER_01: That's a massive number of people who obviously felt the need to get tested, presumably because they're breaking out of their bubble and seeing people that they don't normally see or see more vulnerable people or traveling.
• 25:47
  SPEAKER_01: On the other hand, at least they were doing something to mitigate their risk.
• 25:50
  SPEAKER_01: Now, we see nationally that risk mitigation is imperfect.
• 25:53
  SPEAKER_01: We're witnessing the surge on a surge right now.
• 25:55
  SPEAKER_01: It very clearly seems to be temporally related to Thanksgiving.
• 25:58
  SPEAKER_01: And we're seeing that locally in the broader community inside of our healthcare worker community, but it's a marker of despite all the messaging around trying to keep Thanksgiving small, limited to your immediate bubble, nonetheless, that message is not through to everybody.
• 26:10
  SPEAKER_01: And now we're looking down the tunnel at Hanukkah and Christmas and New Year's and Kwanzaa all coming up to us and wondering are we going to see a repeat?
• 26:18
  SPEAKER_01: So we'll see a surge on a surge on a surge.
• 26:20
  SPEAKER_01: And what can we do to try to mitigate that?
• 26:22
  SPEAKER_01: So I think what we do need to do is share with people what we did witness in Thanksgiving was that it did lead to a large increase in cases, both in the broader community, within our healthcare workers.
• 26:31
  SPEAKER_01: And now we're seeing the rise in inpatient admissions as well that are related to Thanksgiving.
• 26:35
  SPEAKER_01: And then to share some of the stories, the stories of people who felt they were safe, who went to go see a parent, a loved one outside their bubble, and turned out to be one of those unfortunate few who was carrying the virus and did potentially infect somebody and the implications therefore for that person's health.
• 26:49
  SPEAKER_01: As human beings, I think we react much more immediately and much more emotively to stories.
• 26:54
  SPEAKER_01: So to the extent that we can share some of those instances with people to help humanize and make more immediate the theoretical risk to more of a practical concern for their loved ones, I think is an angle to try to mitigate that risk.
• 27:04
  SPEAKER_01: I don't fool myself and say that things will be perfectly.
• 27:10
  SPEAKER_02: Dr.
• 27:10
  SPEAKER_02: Palmore, anything to add on that?
• 27:13
  SPEAKER_03: I absolutely agree.
• 27:14
  SPEAKER_03: I think you know we don't have a control to tell us how many more cases there would have been, how much bigger the spike would have been without all the warnings that were given before Thanksgiving.
• 27:24
  SPEAKER_03: So it's possible that we would be seeing a worse spike and that some people heeded the warnings and we had a smaller spike than we would have had otherwise.
• 27:33
  SPEAKER_03: So I think we should issue the same pleas to our staff for the winter holidays and hope that some people listen.
• 27:39
  SPEAKER_03: We're almost there.
• 27:40
  SPEAKER_03: The vaccine is on the horizon, and we just need people to set their sights on that and try to convince at least some of them to avoid making the winter holiday events into spreader events.
• 27:50
  SPEAKER_02: That's well said.
• 27:51
  SPEAKER_02: I'll quote Dr.
• 27:52
  SPEAKER_02: Colombas said, looking down the tunnel, this has been a long dark tunnel, but there is, as you just mentioned, there's some light at the end of this tunnel.
• 27:59
  SPEAKER_02: We really need to be very careful through this time.
• 28:02
  SPEAKER_02: And what we saw exactly here in New York was very similar to what you have experienced as a spike in testing.
• 28:09
  SPEAKER_02: I think people equate getting tested negative as being safe.
• 28:15
  SPEAKER_02: And that's really a concept that we try to address with everyone that testing itself just tells you that point in time what your status might be.
• 28:23
  SPEAKER_02: And we don't have a perfect system of saying that you are to zero risk.
• 28:28
  SPEAKER_02: Even with negative testing, we have seen papers upon papers on that event about that you might test negative before and then test positive later on.
• 28:37
  SPEAKER_02: And it is possible it happens.
• 28:38
  SPEAKER_02: We just need to continue to message.
• 28:40
  SPEAKER_02: And also, we have seen a lot of people in other states going to shops during this shopping season in a busy, busy shopping malls and all those events as well.
• 28:49
  SPEAKER_02: And sometimes I wonder if that will have further worsening effect.
• 28:53
  SPEAKER_02: So hopefully, we will be able to get through this and continue our messaging.
• 28:58
  SPEAKER_02: I would really want to thank you very much, both of our speakers, for sharing their perspectives and experiences.
• 29:04
  SPEAKER_02: Dr.
• 29:04
  SPEAKER_02: Compass, any final words?
• 29:06
  SPEAKER_01: No, I just want to thank you very much for the opportunity to be able to speak.
• 29:09
  SPEAKER_01: I've enjoyed talking to you both, and thank you.
• 29:12
  SPEAKER_02: And Dr.
• 29:13
  SPEAKER_02: Palmore, any final thoughts?
• 29:14
  SPEAKER_03: Thank you so much.
• 29:15
  SPEAKER_03: I really enjoy joining this group.
• 29:18
  SPEAKER_02: This podcast can be accessed on Shea's online education center, Learning CE, under the Rapid Response Program.
• 29:25
  SPEAKER_02: You will also find resources such as other recorded webinars, healthcare facility, outbreak preparedness, and the SHA COVID-19 town halls.
• 29:34
  SPEAKER_02: You can now receive 50% of 2021 SHA membership using the coupon code WELLCOME2021 during the checkout process.
• 29:43
  SPEAKER_02: That concludes this episode of Rapid Response Podcast.
• 29:47
  SPEAKER_02: Thank you for tuning in.