Science-based guidance for reopening your hospital

2020-9-3 GettyImages-1254704727 Reopening plan - blog.jpg

Lots of hospitals are eager to open their doors and let clients come in from the curb, but aren’t sure how to do it safely. Many are taking to social media to ask for tips from other hospitals.

Most of those tips are valid—hand sanitizer stations in every room, a mask mandate, taking the temperature of everyone who comes through the door—but it’s also clear that nobody’s quite sure what to do, and everyone seems to be operating by the seat of their pants.

So NEWStat wanted to see whether anyone was working on a rigorous, science-based, step-by-step plan on how and when to safely reopen veterinary hospitals to clients.

Our first stop was J. Scott Weese, DVM, DVSc, DACVIM, a contributing reviewer of the 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines. Weese has prepared a series of in-depth guides on how to safely reopen a veterinary hospital prepared on behalf of the Ontario Veterinary Medical Association. All are available on his Worms & Germs COVID-19 Veterinary Resources page.

Nevertheless, he wasn’t encouraging.

There aren’t any step-by-step guides . . . because there’s not a single-step approach to reopening,” he said. “What to do depends on many factors, such as [the number of COVID cases] in the area, hospital layout, risk tolerance, risk status of people in the hospital, ability to implement changes, and things like that.” He says what is available is more of a menu of options that hospitals need to choose from versus a standard plan.

Weese pointed NEWStat to his latest guidance, which “goes over various options, approaches, and control measures. That’s the closest thing to what you’re looking for that I know about.”

Christine Petersen, DVM, PhD, director of the Center for Emerging Infectious Diseases at the University of Iowa suggested some additional resources that veterinary hospitals planning to admit clients might find useful: “There are some general materials that have been put together for reopening different types of businesses, and the US Centers for Disease and Control and Prevention (CDC) put out some specific guidance on personal protective equipment [PPE] and helping with veterinary staffing during COVID.”

Peterson also recommends the American Industrial Hygienists Association’s (AIHA) Back to Work Safely website: “They don’t address veterinary hospitals specifically, but do have guidelines for dental offices and general office space that would be useful to consider in the veterinary setting.”

Meghan Davis, DVM, MPH PhD, an associate professor in the Department of Environmental Health and Engineering at Johns Hopkins Bloomberg School of Public Health seconds Peterson’s suggestions to look to the CDC and AIHA for guidance. And, like Weese, she’s unaware of any ongoing research that specifically addresses the reopening of veterinary hospitals.

But Davis does believe that consideration of engineering and administrative controls—in addition to consistent and proper use of PPE—is essential to the successful reopening of hospitals to clients. To that end, she recommends that hospitals consult the Hierarchy of Controls figure adapted from the National Institute of Occupational Safety and Health (NIOSH) in this article by two of her colleagues. “What this means is changing work practices [such as] distancing [and] workflow protocols—as well as using physical barriers to prevent the spread of the SARS-CoV-2 virus.”

Davis says administrative controls can include one-way movement of people to ensure physical distancing, such as the use of dedicated entrance and exit doors. She also advocates a strategy for multidoctor practices that assigns staff to shift “pods,” where the same veterinarians, technicians, administrative support team, kennel staff, and other workers are assigned the same shifts together, with no crossover and with good disinfection protocols between shifts.

“This way, if one person tests positive, then it will only be the one pod that has to isolate/quarantine and the practice can continue to provide service with the other pod or pods of employees,” she says, and notes that her research lab at Johns Hopkins is currently using this strategy.

“Inside a veterinary hospital, density (number of people per square feet) in relation to ventilation is important to consider,” Davis says. That means limiting the number of clients in a room with the veterinarian as well as the total number of people in smaller exam rooms. And if, for any reason, staff can’t avoid being in close contact with clients in a small room, she recommends they wear goggles or face shields in addition to N95 or similar respirators. “Related to this, there’s also a useful PPE burn rate calculator (including a mobile app version) from CDC/NIOSH that veterinary hospitals may find useful to estimate their ordering needs for PPE.”

Davis cautions that these suggestions may not work for all hospitals: “It may be that [some practices’] buildings are not conducive to engineering or administrative controls, and those practices will have to make decisions about whether they should remain curbside.”

Some hospitals may also choose to remain curbside based on how much COVID-19 is circulating in their community, Davis adds, and only move to reopen when incidence rates have declined in their area.

Davis says her last piece of advice as an infectious disease epidemiologist is for practice leadership and teams to treat the pandemic as a marathon, not a sprint. “There’s still a lot we don’t know about this virus,” she says.

Even if researchers come up with an effective vaccine this fall, Davis says approval, deployment, and penetration into communities is going to take some time: “It’s possible that mitigation measures will have to continue for more than a year.”

Photo credit: © Gettyimages/SDI Productions