Open for Business: COVID-19 Adaptations for Primary Care Facilities

Countless aspects of our daily lives have changed in response to COVID-19. The past few months have been a devastating time of hardship for many. For most folks, it has at the very least been a source of anxiety, frustration, inconvenience, fear, or more likely—a mix of these. For those of us fortunate enough to be returning to our regular workplaces over the coming weeks and months, we have to wonder—what will that look like?

I have been fortunate to work from home over these last few months. Like many of you, I have vacillated between peaks (working in my pjs with my dog beside me) and valleys (postponing many important projects and missing socializing with coworkers). I really am looking forward to returning to the office. And while there is no set date, there have been promising signs that a return to some semblance of normalcy is on the horizon. One such sign is the reopening of dine-in services at some restaurants. This weekend my boyfriend and I dined at a restaurant in Sacramento. It was our first time doing so in over three months and as expected, a lot has changed about the restaurant experience. From taped Xs spaced six feet apart on the sidewalk leading up to the building, to wearing a face covering when away from your table. There was a reduced, disposable menu and every other table was left vacant to accommodate social distancing. We enjoyed our visit, but there was no mistaking it for normalcy!

I was impressed by the restaurant and its staff’s resiliency, efficiency, and professionalism in adapting to this new version of business as usual. As we drove home, I couldn’t help but reflect on what the OWCN’s new “business as usual” would be. Would the Primary Care Facility’s floor be adorned with Xs of tape, spaced six feet apart? Or more importantly, would we be reducing the “menu” of treatments that we can provide to patients? Would our capacity, both for animals and responders, need to be modified to allow for social distancing?

If you are at all familiar with the Network’s responsibilities, you already know that planning and preparedness are central to our mission of providing the best achievable capture and care to oil affected wildlife. Unfortunately, however, our protocols seemed to be missing their “How to Adjust Oiled Wildlife Response Operations During a Global Pandemic” appendices. Whoops!

Thankfully the management team is full of planners. Folks who have made a career out of molding protocols and contingency plans into little bricks of preparedness. Each brick isn’t worth all that much on its own, but when stacked high with its companions, we can stand back and admire the fortress of protection that the OWCN and its partners have built around California’s wildlife. So when we discovered that our fortress had a pandemic-shaped crack, we got to work fortifying it—one brick at a time.

Hazard Controls

I cannot cover every aspect of our COVID-19 Protection Guidelines and Contingency Plans in this blog, but I will share with you some of the “bricks” that I have been working on. First, let’s think about the hazard we are facing—exposure to the novel coronavirus. The National Institute of Occupational Safety and Health (NIOSH) has created the Hierarchy of Controls as a means of determining how to implement feasible and effective hazard control solutions.

Since elimination and substitution of the novel coronavirus hazard are not possible at this time, our COVID-19 Protection Guidelines and Contingency Plans primarily address options for engineering controls, administrative controls, and enhanced PPE (personal protective equipment).

Let’s take a closer look at one example of each, but first—a disclaimer:

The following controls are just a few tools that we have identified to be potentially useful to our operations at the Primary Care Facility. This is by no means an exhaustive list and these controls may not be appropriate for every situation. 

Engineering Control Example:

“Engineering controls are favored over administrative and personal protective equipment (PPE) for controlling existing worker exposures in the workplace because they are designed to remove the hazard at the source, before it comes in contact with the worker. Well-designed engineering controls can be highly effective in protecting workers and will typically be independent of worker interactions to provide this high level of protection. The initial cost of engineering controls can be higher than the cost of administrative controls or PPE, but over the longer term, operating costs are frequently lower, and in some instances, can provide a cost savings in other areas of the process.”

NIOSH

An air scrubber is a portable filtration system that removes particles, gasses, and/or chemicals from the air within a given area. These machines draw air in from the surrounding environment and pass it through a series of filters to remove contaminants.

Objective: To improve air quality inside the facility

Increasing the number of times that air is replaced in the room will dilute the concentration of particles in that space. It is important to note that according to the Center for Disease Control, COVID-19 is primarily transmitted person-person through respiratory droplets. Airborne transmission is different than droplet transmission and there has NOT been evidence suggesting that COVID-19 has airborne transmission. That said, we are erring on the side of caution by using the CDC’s ventilation requirements of human hospitals as a guideline: https://www.cdc.gov/infectioncontrol/guidelines/environmental/appendix/air.html#tableb2

The animal care rooms within the OWCN designed Primary Care Facilities such as the San Francisco Bay Oiled Wildlife Care and Education Center already have HVAC systems in place that provide 10-15 ACH. Portable air scrubbers like the one below will be supplemented in other rooms to increase the ACH. They will also be implemented in the event that our Western Shelter tents are used during a response.

Administrative Example:

“Administrative controls and PPE are frequently used with existing processes where hazards are not particularly well controlled. Administrative controls and PPE programs may be relatively inexpensive to establish but, over the long term, can be very costly to sustain. These methods for protecting workers have also proven to be less effective than other measures, requiring significant effort by the affected workers.”

NIOSH

Objective: To minimize the number of on-site personnel

An Intake Team typically comprises an examiner, a handler, and a scribe. Can this team be reduced without compromising safety and effectiveness? Well the examiner is crucial and an experienced handler is needed for most species, but the scribe… What if the scribe was remote? That could work! A scribe’s duty is to record all of the examiner’s findings from the animal’s physical exam. We are exploring the possibility of scribes and data collectors calling in via speaker phone to communicate with their teammates. This procedure adjustment reduces the number of on-site intake personnel by 1/3.

PPE Example:

Perhaps the most obvious COVID-19 adaptation would be the increase in required PPE. Depending on their functional area in the Primary Care Facility, our responders are already donning a variety of PPE. In oiled areas they will be in tyvek coveralls, nitrile gloves, safety glasses, and shoe covers. PPE requirements are more relaxed in unoiled areas.

Objective: To minimize exposure to hazards including petroleum and COVID-19

N95s are the respirator of choice when it comes to COVID-19 precautions, but as you surely know, they are in short supply and we must first prioritize their availability to human healthcare workers. Alternative face coverings might be used in the facility at the discretion of the response’s Safety Officer. No matter the type of respirator or face covering used, responders may be required to wear them in addition to their regular PPE at all times inside the facility.

Face shields are another article of PPE that we are familiar with, but they are usually reserved for the Wash Team as splash protection. In a COVID-19 Era spill response, we may be requiring face shields in addition to N95s/face coverings for all responders.

Looking Ahead…

It’s important to remember that a wildlife response under COVID-19 (or any pandemic event) will be unlike any other before it. As always, human safety will be the highest priority, but in this case the risks are much higher.

To be able to provide care to any impacted wildlife, we will need to be able first to ensure human safety. As always, the OWCN’s participation in a spill response will be at the discretion of the Office of Spill Prevention and Response and the California Department of Fish and Wildlife. If these agencies feel that the risk to human safety is too great, the OWCN’s activities may be suspended or reduced. It will be critical for us to continually evaluate our methods as well as our own health and if there is any sign of illness, responders must proactively stay away so as not to risk the entire response.

Be safe. Be prepared. Stay healthy.

—Sam

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