Health Advisory
REMINDER OF PPE AND INFECTION PREVENTION GUIDANCE AMID COVID-19 PANDEMIC

The Delaware Division of Public Health (DPH) is issuing this health advisory to provide the health care community with updated information regarding rising cases of COVID-19 in  Delaware and to reiterate guidance regarding Personal Protective Equipment (PPE) conservation and infection prevention strategies when treating or assessing suspected or confirmed COVID-19 patients.

Summary

COVID-19 can spread rapidly from close contacts within and between communities.

From September 1 to September 30, 2020, COVID-19 cases among Delaware residents increased across the state. Increases were greatest in New Castle and Sussex counties. Increases in cases were not solely attributable to increased testing. Additionally, hospitalizations have steadily increased with a proportional rise in severe illness requiring mechanical ventilation.

Delaware residents should take precautions, including wearing masks, social distancing, and practicing hand hygiene, and follow state and federal guidance for minimizing the spread of COVID-19. Providers should take action to conserve PPE and reinforce infection prevention and control strategies.

Background

From September 1 to September 30, 2020, confirmed cases of COVID-19 among Delaware residents increased more than  20%. Increases in cases have predominantly been driven by young adults, however secondary spread within households, families, and close contacts has been repeatedly identified. Hospitalizations have steadily risen, increasing more than 150% over the month.

Recommendations

• Implement controls including practices, procedures, and policies that reduce or prevent hazardous exposures. Examples include engineering controls (e.g., use of physical barriers such as glass or plastic windows at reception areas, curtains between patients, etc.; proper maintenance of ventilation systems to provide air movement from a clean to contaminated flow direction) and administrative controls (e.g., screening patients for acute respiratory illness prior to non-urgent care or elective visits; reduce face-to-face encounters with patients via bundling activities or use of video monitoring)
• Ensure your facility or practice has at least a 30-day supply of PPE. Review contingency and crisis strategies for PPE optimization, including limitation of non-urgent or elective procedures in hospital or outpatient settings.
• Encourage employees and patients to take precautions, including wearing masks, social distancing, and practicing hand hygiene, and follow state and federal guidance for minimizing the spread of COVID-19.
  • Encourage staff to comply with infection prevention and control precautions outside of the work setting.
• Review DPH guidance for Management of Persons with Suspected COVID-19 Exposure, Discontinuation of Home Isolation and Return to Work  (https://news.delaware.gov/files/2020/09/7.27.20-Return-to-Work_RTW_Guidance-final.pdf)
  • Except for rare situations, a test-based strategy is not recommended to determine when to allow personnel to return to work.
    • Persons with CONFIRMED or SUSPECTED COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions:
      • At least one day (24 hours) has passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in symptoms (e.g., cough, shortness of breath); and,
      • At least 10 days have passed since symptoms first appeared.
    • Health care personnel with severe to critical illness or who are severely immunocompromised should extend the period of isolation and may return to work when at least one day (24 hours) has passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in symptoms (e.g., cough, shortness of breath); and at least 20 days have passed since symptoms first appeared.
  • For persons directed to quarantine for 14 days due to being a close contact of a patient with confirmed COVID-19, a negative test does NOT preempt the completion of 14 days of quarantine.
  • For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within three months after the date of symptom onset for the initial COVID-19 infection. In addition, quarantine is not recommended in the event of close contact with an infected person.

Additional Information

• DPH Guidance for Management of Persons with Suspected COVID-19 Exposure, Discontinuation of Home Isolation and Return to Work (Revised, effective July 27, 2020)
• DPH HAN – Strategies for Optimizing the Supply of PPE – N95 Respirators (DPH Issued March 20, 2020)
• DPH HAN – Strategies for Optimizing the Supply of PPE – Facemasks (DPH Issued March 20, 2020)
• DPH HAN- Strategies for Optimizing the Supply of PPE – Isolation Gowns (DPH Issued March 20, 2020)
• DPH HAN – Strategies for Optimizing the Supply of PPE – Eye Protection (DPH Issued March 20, 2020)

DPH HAN – Personal Protective Equipment (PPE) Updated Guidance (DPH issued 3.10.2020)