Written Protocols

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Screening over the phone:

  • Patients calling the Contact Center to request an appointment with primary care clinics will be screened with the screening tool.
  • Calls identified as positive screens will be transferred via phone notes to clinical staff in the respective clinic for call back (within 2 hours) for telephonic evaluation and guidance, and scheduling of an appointment only if needed.
  • The purpose is to minimize visits to the clinics providing advice and possible treatment and follow-up over the phone as deemed appropriate. Each Primary Care clinic must have a process in place to address these calls. Physician involvement here is essential.

Access to Clinic Buildings:

  • Patients may enter using the South, West, and East entrances.
  • Staff, faculty, residents, and students will enter via the North (rear) CSB entrance.
  • Patients will be screened by front desk staff at each clinic.
  • Signage will be posted to inform the public about our screening procedures.
  • All patients and visitors will be screened by the front desk staff. Positive screens will be given a mask and directed to the designated area.
  • Screening is done by EPPC staff at the building entrance. Positive screens are notified to the clinic front desk to decide if needed to be seen in the clinic.

Visitors restrictions:

  • Visitors accompanying patients will not be allowed unless absolutely needed and be limited to 1 per patient.

Designated areas:

All clinics should have a designated area of the waiting room and designated rooms to evaluate or hold positive screen patients.

Screening tool/criteria:

Patients will be asked whether they:

  • are experiencing fever AND (cough AND/OR shortness of breath) for less than 2 weeks
  • are experiencing any of those symptoms for less than 2 weeks AND had exposure to a known case of Coronavirus

(Any positive response will be considered a positive screen)

Management of positive screen patients:

In non-Primary Care or non-designated clinic (EPCC, Schuster, Mesa):

  • Patients should be given a mask and referred to their established PCP (Texas Tech or other) for evaluation of possible infection.
  • If there is absolute need to see the patient, it should be done with the same precautions to be taken in designated areas.

In Primary Care or designated clinics:

  1. Areas and supplies requirements:
    • A designated area in the waiting room segregated from the rest of the general patient population by no less than six feet where screen positive patients and those accompanying them can wait and process check-in, if needed.
      1. This designated area should have a trashcan with a touch-less lid for patients to be able to dispose of any facial tissue or other items.
    • At least one designated exam room for evaluation:
      1. Designated exam rooms should have a trashcan with a touch-less lid immediately by the door for disposal of used PPE and other used supplies
      2. If possible, do not have the patient sitting in close proximity of the door
      3. Designated rooms cannot be used for routine patient exams
      4. Have the door closed when patient is in the exam room
    • Designated staff (medical assistant(s)/nurse(s)/physicians)
      1. These designated individuals should be the only individuals authorized to enter the designated exam rooms and interact with the patient
      2. Designated individuals must have been fit tested for N-95 masks within the last 12 months and don appropriate PPE immediately prior to entering the designated exam room
      3. Designated individuals must remove appropriate PPE immediately prior exiting the designated exam room and must carefully dispose of PPE in the trash can by the exam room door
        1. When leaving the patient room or care area, immediately perform hand hygiene
        2. Reusable eye protection must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to reuse
        3. Cloth gowns should not be used as a gown
      4. New PPE must be donned prior to re-entering the designated patient room
    • Appropriate PPE, to include:
      1. Procedure masks to provide screen positive patients and those accompanying them
      2. Eye protection such as goggles or face shields that covers the front and sides of the face
      3. N-95 respiratory masks for designated staff
      4. Gloves
      5. Gowns
    • Appropriate infection control supplies
      1. PDI Super Sani-Cloths for disinfecting the designated waiting area and disinfecting the designated exam room after each potential case
      2. Hand sanitizer
        1. Hand sanitizer should be readily available throughout the clinic for use by patients, staff, and visitors
        2. Steris hand sanitizing products are the approved product and should be used when possible. Due to the current supply shortage an exception may be made with the approval of the Infection Control Nurse
    • Approved testing supplies
      1. Swabs with a plastic shaft and made with artificial fibers
        1. Swabs with a wooden shaft or made with cotton fiber cannot be used for COVID-19 specimens
      2. Viral transport media
      3. Sputum cups
        1. Sterile urine cups may be used
      4. Cooler (provided by the Office of Occupational Health) to transport specimens
      5. Ice packs for use in cooler during transport of specimens
  2. Evaluation:
    • After a screen positive patient is placed in the designated exam room, vitals should be taken and the usual intake process followed.
    • Testing, treatment and need for referral to the hospital will be up to the clinical judgment of the provider.
    • Consider rapid tests for influenza and/or strep.
    • If testing for Coronavirus is considered needed, the clinic will follow the COVID-19 Specimen Collection and Submission Instructions issued by the Texas Department of Health and Human Services for instructions on obtaining pre-approval for COVID-19 testing. Approval for testing must be obtained from the El Paso Department of Public Health (DPH). Phone number and order forms have been distributed.
      1. If approval is not obtained by the DPH the provider will evaluate and treat per his/her discretion. Information from the CDC regarding COVID-19 should be provided to the patient prior to discharge.
      2. If approval is obtained by the DPH for testing, samples will be taken by clinic designated staff.
        1. Nasopharyngeal swab AND
        2. Oropharyngeal swab
        3. Sputum specimen, if possible
      3. Specimens should be collected as soon as possible after onset of illness, preferably within the first 3-4 days
      4. Specimens must be kept refrigerated between 35°F and 46°F
        1. Only specimen refrigerators may be used. Specimens must NOT be placed in medication or food refrigerators.
        2. Processing specimens: Label samples with two patient identifiers (name and date of birth)
          1. The identifiers must appear on both the primary specimen container and the associated G-2V submission form
            1. Submission Forms must contain:
              1. Two patient-specific identifiers, at minimum
              2. Date of Collection
              3. Test(s) Requested
              4. Billing information
          2. Make sure the patient’s name and other approved identifiers on the form exactly match what is written on the specimen tube
          3. Each specimen container must be labeled as to type (e.g. nasopharyngeal swab, Oropharyngeal swab, etc.)
        3. Secure each sample lid with adhesive tape
        4. Place each specimen inside its own biohazard bag with absorbent paper (chuck)
        5. Place submission forms in the outside pocket of each specimen
        6. Disinfect exterior of each biohazard bag with a Super Sani-Cloth
        7. Place the biohazard bags into a secondary bag
        8. Place the secondary bag into specimen refrigerator until ready for transport
      5. Preparing specimens for transport:
        1. Place secondary bag into cooler provided by the Office of Occupational Health along with sufficient ice packs to keep specimens at required temperature during transport
        2. Notify DPH laboratory of intent to submit samples for testing at 915-212-0438 before taking samples to the laboratory
      6. Specimens must be transported to the DPH laboratory at 4505 Alberta Ave., 2nd Floor.
        1. Clinics at main campus (4801 Alberta Ave.) may be walk specimens to the laboratory by clinic staff.
        2. Off-site clinics must contact Ana Alvarado at 915-929-1251, or Victor Sanchez at 915-215-5655 for transport of specimens to the DHS laboratory.
        3. Individuals leaving specimens at the laboratory must leave only the samples, bringing back the cooler and ice packs to the respective clinics.
    • Post-evaluation
      1. Once a patient has been discharged from the designated exam room, a full cleaning of the room must be done by clinic staff using PDI Super Sani-Cloth wipes.
        1. Full two minute wet time must be maintained
        2. All surfaces that may have had contact with the patient and treating staff/physicians must be wiped down, including, but not limited to, door handles, chairs, exam tables (including retractable foot rest), counter tops, thin client key boards, mouse, sinks, blood pressure cuffs, etc.
      2. The hospital Emergency Department must be notified of any suspected case being referred for admission.

Outreach to patients:

  • All our patients for who we have an e-mail address have received a communication informing them of the precautions we will be taking and what they can expect during their visit.
  • Clinics should post in their waiting rooms the CDC educational materials distributed and hand out to their patients as needed.