Hawaii Island Recovery’s response to the COVID-19 pandemic

1. Overview

(ref. WHO Q&A on COVID-19; https://www.who.int/news-room/q-a-detail/q-a-coronaviruses;
https://www.jointcommission.org/resources/news-and-multimedia/webinars/coronavirus-webinar-replays/preventing-coronavirus-transmission-key-issues-for-all-organizations-to-consider/)

The purpose of this manual is to detail Hawaii Island Recovery’s response to the COVID-19 pandemic. The overall mission of HIR in this context is to (1) reduce the spread of COVID-19 in the general population, (2) mitigate the risk of HIR patients and employees contracting and spreading the virus, and (3) maintain normal programming and operations to the greatest extent possible in order to ensure continued high quality of care for our patients in the facility, our out-patients and their families and relatives.

This manual detail the HIR COVID-19 surveillance plan with infection prevention protocols, quarantine protocols, as well as individual HIR department contingency plans. All HIR COVID-19 protocols align with the recommendations from State of Hawaii, Department of Health, Centers for Disease Control and Prevention, The Joint Commission and the COVID-19 Task Force. The infection prevention protocols dictate responses in preventing personnel, patients, and families from contracting COVID-19. The quarantine protocols dictate responses to prevent the spread of COVID-19 in the event that an employee, patient, or family member has been diagnosed, or has positive symptoms of COVID-19.

This is a living document, and changes in protocol will be reflected here and disseminated to the appropriate parties. Compare the effective date of this document to the most recent distribution to ensure it is accurate. Questions regarding the content of this manual should be directed to Managing Director.

1.01 Covid-19 Symptoms

The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don’t feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. See testing guidelines and symptoms (Appendix F) for more information.

If any of the following symptoms are present, the patient or employee should be quarantined according to the provisions in section 3, and PROGRAM MEDICAL PERSONNEL should be contacted ASAP:

Cough
Shortness of breath
Fever

1.02 Covid-19 Vectors

People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets.

The risk of catching COVID-19 from someone with no symptoms at all is very low. However, many people with COVID-19 experience only mild symptoms. This is particularly true at the early stages of the disease. It is therefore possible to catch COVID-19 from someone who has, for example, just a mild cough and does not feel ill.

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2. Infection Prevention Protocol

(Ref. COVID-19 Guidance for Congregate Settings, https://www.cdc.gov/coronavirus/2019-ncov/community/shared-congregate-house/guidance-shared-congregate-housing.html ; HIR COVID-19 Task Force Quarantine Guidelines; CDC COVID-19 Interim Guidance: https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html)

The infection prevention protocol dictates responses in preventing personnel, patients, and families from contracting COVID-19, while ensuring continued positive program outcomes. These protocols were designed in accordance with CDC recommendations, recommendations from State of Hawaii, Department of Health, The Joint Commission, in collaboration with the COVID-19 Task Force, HIR Medical Director, and numerous industry experts. These protocols will be followed until decided otherwise by HIR Leadership team. Protocols are broken down by department.

2.01 Office/Admin

All business-related travel for HIR employees is suspended, including business development, marketing, and conferences.
Local travel via car should be limited to essential activities only.
Employees are encouraged to limit personal travel as much as possible and abide by all Hawaii Managing orders (safer at home).
Employee activity in the office will be limited to those deemed essential by the Managing Director. This includes limited administrative staff.
Employees coming into the office should immediately follow the procedure on the COVID-19 screening checklist including documenting their temperature & sanitize their hands.
No visitors allowed at the office
When multiple employees are required to be in the office within 6 feet or vehicles, facial coverings should be worn
Hand washes should occur frequently, and not less than every hour.
All non-porous surfaces are to be sterilized with a bleach solution, or disinfecting wipe daily.
All deliveries will be left at the front door; delivery personnel are not permitted in the office.
All HIR personnel should carry a Letter of Essential Personnel (Appendix B) and state or federal picture ID.
All off site HIR personnel still actively working should focus on effective communication daily, utilizing email, SMS messaging, ping, phone calls, and Zoom video conferencing.

2.02 Admissions

Admissions personnel will screen prospects for infection risk factors, including recent travel, illness, location, quarantine, and travel route to HIR (see Appendix I: Guidelines for Admitting New Enrollments)
Admissions personnel will conduct a surveillance interview for prospective patients. Surveillance interviews will be conducted at a minimum within 24 hours of arrival on-site and at enrollment within 2 hours of arriving on-site, prior to heading towards a group
Admissions approvals will be made on an individualized basis by the Managing Director.
Admissions will communicate to patient about abiding by CDC recommendations for sanitation and hygiene precautions, including limiting use of public areas (gas stations, restaurants) and using facial coverings during transport

2.03 Programming

Staff Exchange:

All staff and other support personnel coming into the facility will be assessed for symptoms (including temperature checks) and will be symptom free before going into the facility.
Staff exchange briefing and training activities will follow CDC recommended guidance around social distancing. Staff exchange trainings that require physical contact will be modified or paused during this period except when training is essential to the health and safety of patients and staff
When staff are gathered at buildings or in vehicles, facial coverings should be worn.
Staff will stay 6 feet away from others at all times or wear facial covering when within 6 feet.

Facility:

All activities that incorporate external community contact will be suspended. Outdoor activities that can be completed in the permitted field area will be approved on a case-by-case basis.
Staff and patients are to practice social distancing efforts in and outside the residential facility whenever feasible.
Hand washes are to occur before and after each meal and when returning from the bathroom.
Hand sanitizer should be used frequently throughout the day.
Patients and staff are to have their temperature and symptoms checked and documented daily (see documentation – Appendix E)
Any symptoms of cough, shortness of breath, or fever will be reported ASAP to PROGRAM MEDICAL PERSONNEL, who will collaborate with Medical Supervision to determine appropriate response.
Patients without symptoms will have access to facial coverings. Facial covering is mandatory when leaving the facility, but optional within the facility for treatment purposes. Patients with symptoms will be surveilled and will be provided facial coverings or PPE in line with guidance from Medical Director or other medical professionals
Regular Staff in the treatment facility is required to wear facial coverings when within 6 feet of the patients and other staff members.
If a staff gets sick. Staff stays home until well. And will need at doctor’s evaluation to return for work
External visitors to the Facility will be limited as much as possible. Any visitor will need approval from Managing Director and be required to complete temperature and symptoms check.
Buildings that are in use should have hard surfaces (doorknobs, counters, bathroom spaces) disinfected daily
Vehicles will be supplied with disinfectant spray and have hard surfaces (steering wheel, door handles) sanitized after use

2.04 COVID-19 Task Force

Managing Director has formed a program-level task force responsible for surveillance and assessing on-site COVID-19 conditions and operational readiness. Se Appendix C.

This Task Force will stay updated on the COVID-19 guidelines from The Hawaii Department of Health, CDC and The Joint Commission.

Responsibilities of Task Force include:

Act as local COVID-19 authority
Ensure implementation of COVID-19 Task Force protocols and directives
Ensure on-going compliance with COVID-19 protocols and directives
COVID-19 Task Force will report on weekly quarterback meetings (or more frequently as needed)
Maintain on-going inventory of PPE & Proficient in use of all PPE
Ensure operational readiness for quarantine and isolation protocols
Interface with program patients, staff, and relatives as needed
Establish program for all quarantine/isolation incidents and to staff situations as needed
Maintain quarantine/isolation readiness by preparing physical space and inventory
Provide 24/7 coverage for patients placed in quarantine/isolation
Train program staff on use of PPE
Act as COVID-19 sentinels for program

2.05 Clinical

All clinical employees required to be in the office or at the facility will be assessed for symptoms (including temperature checks) and will be symptom free to be on-site.
Therapists in direct contact with patients will wear facemask and respect the 6ft. bubble with patients and employees, including during sessions.
Therapists will utilize teletherapy when possible.

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3. Quarantine Protocol

(COVID-19 Task Force Quarantine Guidelines; CDC COVID-19 Interim Guidance: https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html)

The quarantine protocols dictate responses to prevent the spread of COVID-19 in the event that an employee, patient, or family member has been diagnosed, has positive symptoms, or has been in contact with someone with a COVID-19 diagnosis. If an employee or patient tests positive for COVID-19 or symptoms are severe with or without a positive test, isolation protocols are observed (section 4). These protocols will be followed until dictated otherwise by the HIR Leadership team.

3.01 Patients

(https://www.cdc.gov/coronavirus/2019-ncov/community/shared-congregate-house/guidance-shared-congregate-housing.html)

If a resident in our facility has COVID-19 (suspected or confirmed) Hawaii Island Recovery follows the guidelines from CDC applicable to our health care setting for Shared or Congregate Housing:

Have the resident seek advice by telephone from a healthcare provider to determine whether a medical evaluation is needed.
Residents are not required to notify administrators if they think they may or have a confirmed case of COVID-19. If you do receive information that someone in your facility has COVID-19, you should work with the Local Health Department to notify anyone in the building who may have been exposed (had close contact with the sick person) while maintaining the confidentiality of the sick person as required by the Americans with Disabilities Act (ADA) and, if applicable, the Health Insurance Portability and Accountability Act (HIPAA).
Provide the ill person with information on how to care for themselves and when to seek medical attention.
Encourage residents with COVID-19 symptoms and their roommates and close contacts to self-isolate – limit their use of shared spaces as much as possible.
- If possible, designate a separate bathroom for residents with COVID-19 symptoms.
- Consider reducing cleaning frequency in bedrooms and bathrooms dedicated to persons with COVID-19 symptoms to as-needed cleaning (e.g., soiled items and surfaces) to avoid unnecessary contact with the ill persons.
- Follow the guidance on when to stop isolation.
Minimize the number of staff members who have face-to-face interactions with residents who have suspected or confirmed COVID-19.
Encourage staff, other residents, caregivers such as outreach workers, and others who visit persons with COVID-19 symptoms to follow recommended precautions to prevent the spread.
Staff at higher risk of severe illness from COVID-19 should not have close contact with residents who have suspected or confirmed COVID-19, if possible.
Those who have been in close contact (i.e., less than 6 feet (2 meters) with a resident who has confirmed or suspected COVID-19 should monitor their health and call their healthcare provider if they develop symptoms suggestive of COVID-19.
Be prepared for the potential need to transport persons with suspected or confirmed COVID-19 for testing or non-urgent medical care. Avoid using public transportation, ridesharing, or taxis. Follow guidelines for cleaning and disinfecting any transport vehicles.

In addition to the CDC guidelines in the event that a staff believes a patient has mild to moderate COVID-19 symptoms as defined in Appendix F, the following protocol will be enacted:

The patient will be isolated in his/her room if in private room or in the Ohana. The patient will wear a cloth facial covering if having to leave the room and when in contact with a staff member.
Additional PPE will be provided to patient and/or group by trained member of COVID-19 Task Force (N-95 or equivalent mask).
Staff will fill out a note in KIPU and contact Program Nurse and Reporting Supervisor
Reporting Supervisor will complete a surveillance report (Appendix C) and email it to the medical director.
Reporting Supervisor will communicate with the medical director to determine if a quarantine is necessary.

The medical director will recommend a quarantine if appropriate. If the medical director does not believe a quarantine is necessary, the group can return to standard infection prevention protocols. If a quarantine is necessary, the following protocol will be enacted – additional procedures outlined in Appendix G:

At the initiation of a quarantine, all patients and staff should receive a shower and clean clothing and have all touched surfaces receive sanitation as appropriate to type
The symptomatic patient will be satellited in the Ohana
All patients and staff will wear PPE
The symptomatic patient will not interact with the other patients, will not participate in group with other patients
All staff interacting with the symptomatic patient will wash hands hourly.
The patient will not hike for the duration of the quarantine.
If the symptomatic patient needs to be transported for any reason, it will happen in the van
Only necessary programming and logistics personnel will interact with the patients at the facility.
Staff using the HIR Vehicles will sanitize it after use.
Staff off-shift who worked with the patient will self-quarantine according to state requirements (safer at home) until consultation with Medical Director.
The quarantine will be lifted at the direction of the Managing Director after consulting with the Medical Director, or if the symptomatic patient tests negative for COVID-19.

The following communication will happen when a quarantine is enacted:

The Managing director or designee will notify relatives and referrals.
Managing director or designee will contact COVID-19 Task Force.
Managing director or designee will contact Executive Manager.
Daily updates on the group and symptomatic patient will be reported by:
- Managing director or designee to medical director
- Managing director or designee to relatives and referrals
- Managing director or designee to COVID-19 Task Force

3.02 Employees

In the event that a staff believes they or another employee has COVID-19 symptoms as defined in Appendix F, or they live with someone who has symptoms, the following protocol will be enacted:

The employee will self-quarantine immediately. If in the facility or the office they will remove themselves at least 25 feet from others, and wear PPE.
The employee will contact a member of the COVID-19 Task Force (1) Jimmy Kayihura (2) Sophie Higgins or (3) David Molletti to fill out a surveillance form with symptoms (Appendix C).
The surveillance form will be sent to the medical director to determine if quarantine is necessary and communicate with employee

The medical director will recommend a quarantine if appropriate. If the medical director does not believe a quarantine is necessary, the employee can return to standard infection prevention protocols. If a quarantine is necessary, the following protocol will be enacted:

The employee will self-quarantine at home.
The employee may be able to work remotely depending on symptom severity.
Any employees that live with the symptomatic employee must fill out the surveillance form and speak with the medical director to determine if they must quarantine as well.
The employee will remain in quarantine until cleared by a doctor, or until they test negative for COVID-19.

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4. Isolation Protocols

(Ref. COVID-19-10 Guidance for Congregate Settings; COVID-19 Task Force Quarantine Guidelines; CDC COVID-19 Interim Guidance: https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html)

The isolation protocol dictates responses to prevent the spread of COVID-19 if an employee, patient, or family member tests positive for COVID-19, or if a patient or employee has severe symptoms with or without a positive test. This protocol will be followed until directed otherwise by HIR Leadership team.

4.01 Patients

If a patient test positive for COVID-19 symptoms or has severe symptoms, the following protocol will be enacted:

The patient will be immediately isolating in his/her room if in a private room or isolated in the Ohana, following the Quarantine Response Plan. The patient’s staff will be informed on PPE equipment & procedures for how to safely put on and remove PPE according to CDC-guidelines by a member of the COVID-19 Task Force.
The patient will wear PPE (N-95 or equivalent mask and gloves) as will the staff (N-95 or equivalent mask, and eye protection; gown or altered clothing options)
The group will follow all disinfecting protocols as defined in section 3.
All staff interacting with the symptomatic patient will wash hands hourly.
The patient will not hike for the duration of isolation.
If the isolated patient needs to be transported for any reason, it will happen in the designated HIR vehicle by the staff working with the patient and the vehicle will be disinfected after use.
No outside employees that are not trained by the COVID-19 Task Force will interact directly with the patient (interactions will still be allowed via telecommunications as appropriate)
Staff off-shift will self-quarantine according to state requirements (safer at home)
The isolation will be lifted at the direction of the Managing director who will consult with the Medical Director, or if the symptomatic patient tests negative for COVID-19
During isolation, the following minimum PPE expectations would be followed:
- Within 10’ of patient or while interacting with patient gear– wearing N95/equivalent mask, goggles, medical gloves and gown/equivalent clothing
- Within 25’ of patient – wearing facial covering and eyewear
- Greater than 25’ – no PPE required

The following communication will happen when a group quarantine is enacted:

The Managing director or designee will notify relatives and referrals.
The Managing director or designee will contact the COVID-19 Task Force.
The Managing director or designee will contact the Executive Director.
The Managing director or designee will contact HIR’s OCHA Representative.
Daily updates on the group and symptomatic patient will be reported by:
- Managing Director to medical director
- The Managing director or designee to relatives and referrals
- The Managing director or designee to COVID-19 Task Force

4.02 Employees

In the event that a staff tests positive for COVID-19 or has severe symptoms with or without a positive test, the staff will isolate at home until cleared by a doctor, or if they test negative for COVID-19

4.03 Family Members

If a patient family member tests positive for COVID-19, they will not be permitted in the facility or in the office

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5. Department Contingency Plans

Individual HIR – department heads are responsible for maintaining a contingency plan that details essential employees that must be physically present in the office and facility, and coverage in the event that essential personnel are sick and unable to work. In the event that there are insufficient staff for all essential positions, staffing the facility will take priority.

5.01 Office/Admin

Essential Positions:

Managing Director
Office Administrator
Quality assurance Specialist

Coverage options:

Office Assistant
Intra-departmental support

5.02 Admissions

Essential positions:

Admissions Director
Patient Care Coordinators
Addictionologist/ Registered Nurse

5.03 Programming