July 1, 2022


We are committed to protecting the health of our patients, families, and CHKD team members during the COVID-19 pandemic. We are working with campus partners; Federal, State and Local Government; VDH; CDC; and unified community emergency operations to maintain best practices for our care delivery.

COVID-19 Vaccine Information - Updated May 25

CDC expands eligibility of COVID-19 boosters for children 5-11 years of age

The Centers for Disease Control and Prevention (CDC) and Virginia Department of Health are recommending all children 5 – 11 years get the Pfizer-BioNTech COVID-19 booster if they completed their primary series of the Pfizer-BioNTech vaccine five months ago or more.

On May 19, the CDC recommended a booster for children, ages 5–11, following the expansion of the pediatric vaccine’s Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) earlier in the week.

In addition, the CDC strengthened their recommendation that persons 12 years and older who are immunocompromised and those 50 years and older should get a second booster vaccine if it has been four months since their first booster.

Everyone five years or older is eligible to be vaccinated. To find free vaccination opportunities near you, visit vaccinate.virginia.gov or call 877-VAX-IN-VA (877-829-4682, TTY users call 7-1-1). Assistance is available in English, Spanish, and more than 100 other languages.

COVID-19 Vaccination - Second Booster Dose Now Authorized

As of March 29, the FDA has authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines for anyone over age 50 or those with certain types of immunocompromise. Emerging evidence suggests that a second booster dose improves protection against severe COVID-19 and is not associated with new safety concerns.

At CHKD, we highly recommend that anyone eligible for a second booster receive one as soon as possible. As these booster vaccines are freely available, we will not be offering this vaccine through Occupational Health. To find a vaccination location convenient to you, enter your zip code at this link.

Am I Eligible for a Second Booster Dose?

  • If you are 50 years of age or older, you may receive a second booster dose of the Pfizer-BioNTech or Moderna COVID-19 vaccine at least 4 months after your first booster was given.
  • If you are age 12 or older and have a compromised immune system, you may receive a second booster dose of the Pfizer-BioNTech vaccine at least 4 months after your first booster was given. This includes individuals who have undergone solid organ transplantation or are living with a condition that is considered to have an equivalent level of immunocompromise.
  • If you are 18 years of age or older and are immunocompromised, you may receive a second booster dose of the Moderna vaccine at least 4 months after your first booster.
  • Anyone age 18 to 49 years who received the Janssen COVID-19 vaccine as both your primary and booster doses may receive a second booster dose of an mRNA COVID-19 vaccine. This second booster should be given at least 4 months after your Janssen booster dose. Immunocompromise is not a requirement.

From Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research FDA:

“Current evidence suggests some waning of protection over time against serious outcomes from COVID-19 in older and immunocompromised individuals. Based on an analysis of emerging data, a second booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine could help increase protection levels for these higher-risk individuals. Additionally, the data show that an initial booster dose is critical in helping to protect all adults from the potentially severe outcomes of COVID-19. So, those who have not received their initial booster dose are strongly encouraged to do so.”

- COVID-19 Testing - Updated May 6, 2022

SBAR: Reimplementation of COVID Testing Program

Situation:

CHKDHS began on-site testing for SARS-CoV2, the virus that causes COVID-19, in April 2020 for pre-procedural and admitted patients. Due to declining community transmission and low rates at CHKDHS, this program was halted in April 2022, with continued monitoring of symptomatic testing rates. The decision was to re-start testing in this population once testing reached 10% positivity.

Background:

Over the past week, the percent positivity for SARS-CoV2 testing has steadily increased from 2% to 10% as of May 4.

Assessment:

Due to increased community transmission, we will be restarting asymptomatic testing in the pre-procedural and admitted patients. Therefore, all patients undergoing procedures requiring sedation, anesthesia, or risk of aerosol-generating procedures will be tested 48-72 hours prior, as was done in the past. All patients admitted to CHKD will require testing prior to bed placement.

Recommendations:

1. Starting May 5, all patients admitted to CHKD will require SARS-CoV2 testing. The type of test will be determined by the treating team. Cepheid SARS-CoV2 PCR is recommended for asymptomatic patients. For those patients with respiratory symptoms, the choice is RP2 (22 respiratory targets) or Cepheid SARS-CoV2 PCR.

2. Starting May 9, all patients undergoing procedures will require testing 48-72 hours PRIOR to the procedure. The same patients that required testing in the past will require testing now. Please send Cepheid SARS-CoV2 PCR

3. Testing will continue until rates decline. We will reassess in June 2022.

Infection Prevention and Control - Updated July 1, 2022

New PPE Requirements/Chart for Respiratory Illness

CHKD has issued new PPE requirements. Please review these, print them out for reference, and discard any previous versions. 

Highlights of the changes include the following:

  • Added a clarifying header to the aerosol generating procedures (AGPs). No other changes were made.

In addition, please note the following information that has not changed from earlier versions.

  • Intubations on all patients require N95s.
  • N95s or higher level respirator, eye protection, gowns, and gloves are still required for patients on Enhanced Contact/Droplet.
  • Masks and eye protection are required for patients on Droplet Precautions for all suspected/known viral respiratory infections.
  • Aerosol-generating procedures (other than intubations) performed for patients not on transmission-based precautions still require a mask and eye protection during these procedures (Standard Precautions).

COVID-19 Precautions for All Buildings Housing Clinical Areas

The following requirements are in place for all CHKD facilities that patients visit.

  • Masks are still required for everyone.
  • Eye protection is no longer mandated for standard care or routine interactions for those in patient-facing roles. Eye protection shall still be worn according to the PPE requirements outlined in the PPE chart dated March 29, 2022. Anyone who wishes to use eyewear may continue to do so.
  • In conference rooms and breakrooms away from the public with closed doors:
    • Vaccinated team members may unmask with no social distancing. Masks must be put back on before entering public spaces.
    • Unvaccinated team members must maintain 6 feet or greater from others if the breakroom is shared. If social distancing is not possible, the break should be taken separately or in an area that allows for social distancing. If social distancing in a meeting room is not possible, a mask must still be worn.
    • Anyone who wishes to continue wearing masks and social distancing should feel free and comfortable to do so.

Update on Pre-procedure and Admission Testing - March 28

In April 2020, CHKDHS instituted testing for SARS-CoV2 for all patients prior to any surgeries or procedures requiring sedation and for all patients admitted to the hospital. We are now at low levels of disease in the community, with percent positivity for both symptomatic and asymptomatic patients decreasing weekly.

CHKDHS will no longer require testing for SARS-CoV2, the virus that causes COVID-19, for asymptomatic inpatient admissions or pre-procedures beginning April 2, 2022. Therefore, any surgery/procedure scheduled April 4, 2022 or beyond, will not require testing for SARS-CoV2, as long as the patient is asymptomatic. As a reminder, all intubations/extubations or other aerosol generating procedures will continue to require the wearing of N95 respirators and eye protection, as these recommendations have not changed under the CDC guidance.

It is still expected that all symptomatic patients will have respiratory pathogen testing as indicated clinically.

We will continue to monitor CHKDHS data, and if the percent positivity increases to 10 percent or greater, the testing program will be re-started.

Changes to COVID-19 Isolation and Quarantine

The CDC updated its IPAC recommendations to reflect new guidance for isolation and quarantine, along with consideration for vaccination status. CHKDHS has updated its guidance to reflect these changes.

Currently, CHKDHS patients infected with COVID-19 and those under investigation are placed under "enhanced contact and droplet isolation," with adjustments as needed based on updated federal and state standards. Changes will not affect those PPE standards but will address the length of isolation based on patient immune system status and severity of illness. Removal of enhanced isolation will continue to require IPAC approval.

Updated recommendations are as follows:

  1. Empiric use of enhanced contact/droplet precautions (quarantine) is recommended for patients who have had close contact with someone with SARS-CoV2 infection if they are not up to date with all recommended COVID-19 vaccine doses for 10 days following their last contact with an infected person. This includes persons under investigation (PUI) and parents.
  2. Quarantine is NOT needed for patients/parents who have had close contact with SARS-CoV2 infection or who have had COVID-19 infection within the past 90 days IF they are up to date with all recommended doses of COVID-19 vaccine doses. This will require proof of vaccination either from the VIS database or a vaccine card. This will be verified by the medical or surgical team the patient is admitted to.
  3. For the infected patient: the duration of the isolation is dependent on immune status. For those with a normal immune system, isolation is 10 days from the first day of symptoms/positive test along with no fever for 24 hours and improving symptoms in those with no, mild, or moderate symptoms. Those with severe symptoms require at least 20 days of isolation, and testing is considered to remove isolation.
  4. For the immunocompromised, isolation is at least 20 days, with SARS-CoV2 testing performed on day 20 and day 21 to remove isolation precautions under the direction of IPAC for inpatients. If any test is positive (PCR or rapid antigen), the isolation continues. Testing may be repeated every seven days until negative. If the testing is negative, isolation may be discontinued with IPAC approval for inpatients.

Click here for the full SBAR.

Why the Change to N95 Use for COVID-19

As many of you are aware, a change to N95 respirator use was recently made. Read why this was necessary here.

Safety Regulations for Common Areas

The Virginia Occupational Safety and Health Program (VOSH) and Virginia Department of Labor and Industry (DOLI) have recently released new Emergency Temporary Standards to slow the spread of COVID-19. While CHKD policies already meet or exceed most of the standards, we will be adopting new practices for common areas like conference rooms and break rooms to be in compliance with this new guidance.

All employees are required to:

  • Adhere to maximum occupancy requirements in common areas, e.g., break and conference rooms. Facilities personnel will be visiting all sites to measure and determine maximum occupancy. Signs will be installed listing maximum occupancy.
  • Complete proper hand hygiene before and after eating and drinking.
  • Maintain at least six feet of distance between you and others whenever you take your mask off.
  • Clean and disinfect the immediate areas you use in common areas, e.g., break and conference rooms, prior to leaving the area. Please use CHKD-supplied cleaners and disinfectants, which meet requirements to kill SARS CO-V2 and other pathogens. These can be ordered by managers/directors who will receive ordering instructions via email. Each product has a "Contact Time" or total time it takes to kill the germs.

    Thank you in advance for keeping our shared workplaces as safe as possible.

    Protecting Yourself from Infection

    Please access the updated PPE requirements here. And please don’t hesitate to contact Infection Prevention and Control for any clarification or questions.

    Department Handouts and Signs

Treatment Guidelines - Updated Regularly

Visitor Limits - Updated March 25, 2022

Visitor restrictions as of March 25, 2022

With a greatly reduced level of COVID-19 in our community, CHKD has established the following visitor guidelines.

Doctor's Appointments, Outpatient Surgeries, and Urgent Care: Two adults may accompany a patient.

Hospitalized Patients: Children may have four designated adult visitors for the duration of their stay. Two visitors may be at a patient's bedside at a time. Medical assistants who help with activities of daily living are always allowed.

Hospitalized patients with a positive COVID-19 test, and patients under investigation for COVID-19 may have two adult visitors (parents or guardians) for the duration of the inpatient stay. Visitors are required to remain at the patient's bedside while at the hospital, but are allowed to leave/return (walking between the front door of the hospital and the patient's room) once per 12-hour nursing shift. Masks are required at all times.

Visitors to all CHKD facilities are required to wear a mask over their nose and mouth at all times, including inside patient rooms (except when sleeping).

    Authorized Visitor Designation Form

    Download a copy of the visitor designation form here - (December 2021)

    CHKD COVID-19 Dashboard - Updated Weekly

    Statistics for CHKD Covid-19 testing will be provided daily for employees interested in seeing the data trends. A few key points when reviewing these visualizations:

    • Test data represents the PCR and RP2 tests we perform at CHKD on CHKD patients starting on 03/01/2020.
    • Antibody testing data is not included

    We will update these slides daily with the most current data.

    Occupational Health - Updated April 1, 2022

    COVID-19 Consent Forms

    COVID-19 Immunization Consent Form - English

    COVID-19 and Pregnancy

    The CDC’s list of underlying medical conditions that put individuals at increased risk for severe illness has been updated and now includes pregnancy. The CDC advises that COVID-19 infections may also increase the risk of adverse pregnancy outcomes, such as preterm birth. Read more here. In addition, the CDC reminds women who are pumping breast milk at work to take extra cleaning precautions.

    Any employee who would like to request accommodations based on their level of risk should contact occupational health at (757) 668-7852.

      Criteria for Employees Exposed to COVID-19

      • Employees who have been exposed to the COVID-19 virus at work will be assessed according to the CDC risk exposure factors, available at this link: CDC Exposure Risk Categories in Healthcare Personnel. If the employee is quarantined, a leave of absence will be provided.
      • Employees who have been exposed to COVID-19 outside of the workplace through personal contact or travel will be assessed according to CDC guidelines. If they are quarantined, these employees will be eligible to use their paid leave banks.

      Concerned About Exposure?

      If you are worried that you have been in contact with a community or family member under suspicion for COVID-19 (NOT CONFIRMED), please contact your PCP, urgent care, telehealth provider, or connect to MDLIVE, by signing in to your secure member portal or the Optima Health mobile app for advice. Please keep your manager up-to-date with results, and then please contact the relevant department listed below for return to work guidance.

      Return to Work Guidance

      All return-to-work guidance after COVID-19 exposure or infection must be coordinated through the proper channels: Occupational Health for CHKD Health System employees, Dr. Randall Fisher for CSG providers and employees, and through Infection Prevention and Control for contractors, vendors, and others. A negative result from an at-home test is not sufficient for return to work.

      Human Resources - Updated April 26, 2022

      The Occupational Safety and Health Administration (OSHA) has withdrawn the COVID-19 Emergency Temporary Standard (ETS) order they put in place on 8/15/21. This order covered weekly payments up to $1400 to employees using benefit leave and regular pay, payments for time missed to get the vaccine and next day reactions to the vaccine if unable to work. CHKDHS has followed this order and will continue to monitor should a new order be put in place. In the meantime, beginning with our pay period that starts on May 1, 2022, our pay practice for paying employees who are medically removed due to COVID-19 will resume to the pay practice in place prior to 8/15/21. Payment will be as follows: EIB, Sick, PTO and when all leave hours are exhausted, No Pay.