Testing of asymptomatic healthcare workers
Last Updated May 25th, 2020 at 8:27 p.m.

On Friday the Premier announced testing for frontline healthcare workers who are asymptomatic. If you work at St. Joe’s, are asymptomatic and believe you should be tested for COVID-19, you can call 905-573-4844 to make an appointment to be tested at the East End Assessment Centre.

As has been our practice for some time, those employees and physicians who have one or more symptoms OR have been in contact with a person testing positive, will be tested at our Charlton site, near the Fontbonne entrance. 

PPE selection and mask guides
Last updated April 30, 2020 at 4:46 p.m.

With the move to everyone wearing a procedure mask once they pass screening at the hospital entranceways, there have been some questions about proper mask wearing and how to select proper PPE. Remember - procedure masks must now be worn in all areas of the hospital at all times at all sites, with some exceptions such as when other PPE is required, when working alone, or when eating lunch in an area where 2-metre social distancing can be done.

The following resources have been made available:

• Proper mask usage
• Mask and respirator guide
• Point of Care risk assessment guide for PPE

Mask use and conservation
Last updated April 27th, 2020 at 7:21 p.m.

It is essential that everyone at St. Joe’s follow proper mask use, social distancing and meticulous hand hygiene. Last week, St. Joe’s announced three areas of Healthcare Worker COVID-19 outbreak. Effective this past weekend, everyone is St. Joe’s is expected to be wearing a procedure mask at all times, in both clinical and non-clinical areas. Exceptions are areas where individuals are working alone, or on breaks where appropriate social distancing can be maintained.

To help with Personal Protective Equipment (PPE) conservation, these two guides have been updated for the Charlton and West 5^th sites.

• West 5^th Mask conservation visual guide
• Charlton Mask conservation visual guide

Two masks for all staff/physicians working in clinical areas
Last updated April 9th, 2020 at 7:00 p.m.

Effective at 7 p.m. tonight, all staff and physicians working in clinical areas will be provided two procedure masks after passing through screening at the designated staff entry points to our facilities.

This is for everyone working in clinical areas, and that includes the support services such as porters and environmental services who enter into clinical areas.

Two new masks will be supplied each shift.

We have made this decision now in the interest of safety across the organization, knowing that spread of COVID-19 is well into the community, and with a recent arrival of procedure masks to our organization to support this move.

Mask conservation remains vital as getting supplies of personal protective equipment (PPE) remains a challenge. St. Joe’s is committed to having appropriate PPE for our healthcare workers today, and in future days and weeks ahead as the pandemic evolves. This can only be accomplished through measured, judicious use of PPE.

Proper infection prevention measures are essential at all times. It is safe to wear your mask for multiple patient encounters; in fact, you may reduce the risk of self-contamination by reducing the number of mask changes. Please consume masks wisely with both conservation and safety in mind.

Effective 7 p.m. tonight (April 9 2020):

• When you go through screening at the designated staff entry points, as always, have your ID badge ready in a manner that is easy to view
• After showing that you have passed the screening questions on the digital app (or answering the screening questions), you will be asked if you work in a clinical area. As a reminder, this includes anyone required to enter clinical areas such as porters, environmental services, nutrition services, social workers, nurses, physicians, etc.
• If you work in a clinical area, you will be given a paper bag with 2 masks inside.
• You will be expected to don the mask before you enter the clinical area.
• The intent is to use one mask for each half of your shift.
• Used masks will be deposited in the procedure mask collection bins on the  units.
• If you are taking a break at times other than half-way through the shift, the expectation is to carefully place the mask on a clean surface. Please ensure you follow infection prevention control measures of washing hands before donning and doffing your mask.
• Those travelling between units (example porters) will be asked to leave the mask on between clinical units, to help to reduce the risk of self-contamination by reducing the number of mask changes.
• There may be other areas where masks will be provided if proper physical distancing is not possible (Example: information desk).

A procedural mask can be used over the course of many patients. Conserve your mask for as long as possible, but once wet, damaged, or soiled, you should immediately dispose of the mask. If your mask is visibly soiled or damaged dispose of it in the usual garbage. All other masks should be placed in the collection bin to be sent for potential reprocessing. Please do not take any used masks out of the hospital.  Take care not to touch your mask when it is on your face, and if you do, immediately perform hand hygiene.

The plan for use and distribution of procedure masks will be refined and adjusted as we move forward. If you have further questions please pass them along to your supervisor, so that we may work through any further changes based on feedback.

Personal Protective Equipment
Updated April 3rd, 2020 at 12:40 p.m.

St. Joseph’s Healthcare Hamilton (SJHH) is doing everything possible to keep everyone safe now, and throughout the pandemic. The appropriate stewardship of our supply of N95 and procedural masks requires consideration of safety combined with strategies to both reduce inappropriate use and conserve supply.

With this in mind, effective March 30, 2020, based on the Provincial Personal Protective Equipment (PPE) Use During the COVID-19 Pandemic: Recommendations on the use of conservation of PPE from Ontario Health, released on March 25, 2020, and developed by our own experts, we are implementing a new framework on the use of masks. Click below to learn more:

• COVID-19 Update on Masks and Healthcare Worker Personal Protection (Included in Email Update #29, Sent April 3rd 2020)
• Healthcare Worker Personal Protection Decision Framework PDF - Updated April 16, 2020
• Mask Conservation Visual Guide PDF - Updated April 16, 2020

Protected Code Blue
Last Updated April 15th, 2020 at 6:00 p.m.

St. Joe’s has implemented a Protected Code Blue Policy (PCB) to help protect our healthcare workers and patients, and to help reduce the spread of COVID-19. Protected Code Blue is a specialized response to a life-threatening event and will replace the normal code team response to ALL Code Blue calls during the COVID-19 pandemic.

A Protected Code Blue response should be triggered early, at the first signs of decompensation, when possible (such as increasing oxygen requirements or increased work of breathing).

In addition the Department of Anesthesia has organized to have 24/7 coverage for anesthesia support for protected intubations and for protected code blues effective April 14, 2020. There will be a dedicated anesthesiologist for these calls and he/she can be reached at ext. 31210.

Please read more about Protected Code Blue here:
*Note: you must be on the St. Joe's network to access these policies via the links below. 

Charlton: http://mystjoes/policies/Policies/PROTECTED%20CODE%20BLUE.pdf

West 5th: http://mystjoes/policies/Policies/CODE%20BLUE-%20Protected%20Code%20Blue%20West%205TH%20Campus.pdf

Protected Code White
Last Updated 3:01 p.m. on April 16th, 2020 

St. Joe’s has implemented a Protected Code White as a means to provide added safety measures for our healthcare workers and for our patients during the COVID-19 pandemic.

A Protected Code White is an enhanced emergency procedure that provides an immediate and safe response to assist with a situation in which there is violence or threat of violence to self or others where additional resources are required to manage the situation safely. During COVID-19, Code White teams will respond to all Code White situations using the Protective Code White protocol. The Protected Code White Response Team provides a timely response and are equipped, skilled and trained in de-escalation techniques and the use of restraints for patients for all Code Whites, including those that are suspected/positive of COVID-19.

For information about Protected Code White at both the Charlton and West 5th Campus sites, please go to:
*Note: you must be on the St. Joe's network to access this policy via the link below.  http://mystjoes/policies/Policies/CODE%20WHITE.pdf

Staff/Physician Screening and Entrances
Last updated March 25, 2020 at 8:30 p.m.

Everyone entering Charlton, West 5th and King Campuses will be screened for COVID-19 effective Tuesday, March 17 at 6 a.m. We are restricting access to these buildings by locking doors and designating specific entrance points. 

We have also begun checking temperatures of both staff/physicians and patients/visitors as part of the COVID-19 screening process when entering the building. We are using no-touch thermometers.

Access to buildings are restricted and staff and physicians must use designated entrances, noted below. Do not forget your St. Joe's ID badge. 

Digital Tool for Screening at Entrances

Use the digital tool available for staff/physicians to move through the screening process faster.

Visit https://sjhhscreening.com to use your St. Joe's username and password to login. We have adjusted the online digital screening tool so that those without a St. Joe’s login have the option to use before they enter the building. This includes staff such as Environmental Services, Nutritional Services (anyone without a St. Joe's email). 

If you pass the screening, you can show the confirmation screen on your smart phone to the screener, along with your ID badge. A reminder to staff/physicians using the digital screening tool, that the questions must be answered each day before arriving for your shift.

Click here to access a User Guide.

Screening Entrances Per Campus:

The following entrances are the only points of entry and exit for staff and physicians, per Campus:

*NOTE: if you are a patient/visitor, please click here for details on your dedicated entry points.

Charlton Campus:

• Fontbonne Entrance
  Open 6:00 a.m. to 9:00 p.m., 7 days a week
  Note: this entrance is also for patients and visitors
  
  
• Roof deck Entrance (St. Joseph's Drive) 
  Open 6:00 a.m. to 9:00 p.m., 7 days a week
  Note: this entrance is also for Labour and Delivery patients and Patient Transport
  
  
• James Street South Entrance (South of the main patient Emergency Department Entrance)
  Open 24 hours, 7 days a week
  Note: this entrance is also for EMS

West 5th Campus:

• Main Entrance (West 5th Street), Level 1 
  6:00 a.m. to 10:00 p.m., 7 days a week
• Outpatient Entrance (Fennel Avenue), Level 0 
  6:00 a.m. to 2 p.m., Monday to Friday

King Campus:

• Main Entrance
  6:25 a.m. to 5:00 p.m., Monday to Friday
• Dialysis Entrance 
  6:30 a.m. to 11:30 p.m. Monday to Friday
  6:30 a.m. to 5:30 p.m., Saturday and Sunday

REMINDER: You will need to answer screening questions before you can enter.

Physical distancing for safety
Last Updated April 29th, 2020 at 8:18 p.m.

Are you doing everything possible to maintain a safe distance from others? It’s critical that we continue to practice physical distancing to keep everyone safe and limit the spread of infection.

Please maintain a safe physical distance of six-feet (two-metres) from others at all times. Here are some key areas where this is especially important:

• Team rooms and cafeteria during mealtime or breaks
• In the elevator; If the elevator does not allow for physical distancing, wait for the next elevator
• When talking and/or walking with others
• During team huddles
• While waiting in lines

Thank you for helping to maintain a safe patient care and work environment for everyone.

Last Updated April 17th, 2020 at 7:30 p.m.

Each day we need to be intentional in keeping each other safe. We are all going through screening, we are using more alcohol hand hygiene than we ever have before to make sure we are meticulously cleaning our hands, we have prompt testing for any of us that have symptoms, we are using technology to help with social distancing. The social distancing is not always easy, but in this regard we are asking everyone to think about staff congregate spaces like staff rooms. We are in this together but must all be keeping each other safe.

In your area work out how many people can be in the space at the same time. Some areas have removed chairs and marked the floor as a way of queueing each other and stressing how many people can be in this area.

The best ideas on this will come from your direct team. Just like we have said for years on hand hygiene "remind me if I don’t wash my hands," keep that up and ALSO "REMIND me if I am in your space."

Taking further measures to help keep us all safe
Last Updated April 24th, 2020 at 8:31 p.m.

St. Joe’s is currently experiencing three healthcare worker COVID-19 outbreaks. This is a situation facing many hospitals today. Our patient-related COVID-19 outbreaks have been well-controlled thanks to you coming to work only when well and completing active screening at the beginning of every shift. Your diligent hand hygiene and appropriate use of PPE have all contributed to this good outcome.

We need to focus on healthcare worker-to-healthcare worker transmission. We are providing additional informational resources and adding precautionary measures:

• Universal masking across all areas of St. Joe’s

Effective Saturday, April 25, all staff and physicians entering St. Joe’s facilities will be asked to wear a procedure mask at all times.

Since April 9, clinical staff were provided 2 masks after passing screening at staff entranceways. Now all staff and physicians will be provided the masks and are expected to wear them immediately.

Masks must be worn in all clinical and non-clinical areas. Please wear your mask at all times except when eating or when alone in a room, including common areas where you are likely to come into contact with others such as the lobby, line-ups, elevators and lounge areas. Help us keep each other safe as we depend on each other to do this well.

• Greater physical distancing at breaks

It is difficult to know where transmission happens, but we need all healthcare workers to follow strict physical distancing of at least two metres when we are not wearing masks. This includes shared time at breaks whether having a meal or just a conversation while not wearing a mask.

We recognize that sharing time together and supporting each other is important. We are trying to help do that in a safe way. To that end we are trying to open up other areas within the hospital to allow you the ability to share space but maintain the physical distancing that is so critical to prevent transmission of infected droplets. We will be creating signage to guide you and remind you where you can be space-safe.

• Resources to better understand contact tracing and keeping each other safe

Please review these printable resources on what we can do to keep each other safe, and information on contact tracing:

1. Contact tracing
2. Helping to keep each other safe

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Our staff and physicians follow meticulous hand hygiene practices. Click here to learn more about hand hygiene at St. Joe’s.

To prevent the spread of infectious diseases and to keep healthy, follow these simple steps:

• Stay home if you are sick
  Return when you are well
• Wash your hands
  Use soap and water or hand sanitizer
  WATCH HERE as our expert shares the DOs and DONTs of proper handwashing with Ben Mulroney on CTV's Your Morning
• Cover your cough or sneeze
  With a tissue or into your sleeve
• Keep your distance
  Avoid shaking hands and close contact with people who are sick

A reminder to all staff and physicians that, at all times, if you are sick or feeling unwell with respiratory symptoms and fever, or nausea, vomiting, and/or diarrhea stay home and only return to work when you are well.

Changes to testing of healthcare workers returning to work after COVID-19 infection
Last Updated May 11th, 2020 at 7:23 p.m.

The Ontario government on May 2^nd changed its recommendation around the return-to-work requirements needed for healthcare workers (HCW) who have tested positive for COVID-19.

As a result, effective Saturday, May 9, St. Joe’s healthcare workers who have tested positive for COVID-19 must follow these criteria to be cleared for returning to work:

• Self-isolate for 14 days after onset of symptoms; and have at least 72 hours of improved symptoms and no fever
• If the person developed no symptoms, return to work would be after a full 14-day self-isolation from when they tested positive
• A worker who was sick enough to be hospitalized requires two negative NPS tests for COVID-19 at least 24 hours apart prior to return to work.

Previously, all healthcare workers who tested positive for COVID-19 required two negative test results after the 14-day self-isolation. Increasing evidence shows that, in most cases, after 10 days the person is no longer transmitting live virus particles that can infect someone else. Because tests are so sensitive, swabs may still detect bits of the virus particles and result in a positive test for up to several weeks later.

Returning to Work After COVID-19
Last updated March 18th, 2020 at 5:30 p.m

To follow Public Health’s current clearance protocol for returning to work after confirmed COVID-19, staff, doctors, and learners must:

• Be asymptomatic
• Have 2 negative nasopharyngeal swabs at least 24 hours apart
• Notify Employee Health/Occupational Health and Safety of your return to work at 905-522-1155 ext 36131 or email Covid19@stjoes.ca

Travel Between Sites
Last Updated March 13, 2020 at 8:00 p.m.

Effective immediately we are asking staff and physicians to avoid all non-essential travel between sites. Please work with your manager or chief if you have any questions about this.

Guidelines on meetings and gatherings at St. Joe’s
Last Updated March 13th, 2020 at 8:00 p.m.

Effective immediately and until further notice, we are asking staff and physicians to: Consider whether a meeting needs to happen at all. Replace in-person group meetings with virtual meetings using teleconferences and video conferencing when possible. If face-to-face meetings are essential, the room must be large enough to accommodate space (ideally two metres) between participants. Cancel conferences, corporate events and corporate social gatherings (example Retirement Tea). Do not attend in person conferences or speaking presentations for work. Note that in-person Employee Wellness programs are being suspended until further notice. Digital resources remain available on MyStJoes > Employee Wellness.

No Food or Drinks in Clinical Areas
Last updated March 20, 2020 at 7:15 p.m.

Eating and drinking are not allowed in the hospital’s clinical areas. This includes all lidded cups, thermoses and water bottles. Please restrict those to staff lounges and the cafeteria.

Last updated April 9th, 2020 at 7:00 p.m.

In the midst of COVID-19, Zoom videoconferencing tools have allowed us to safely continue to provide care to our patients, and to work together from a distance during this exceptional time. At the same time, we are very aware of the various concerns and allegations currently circulating about the privacy and security of Zoom, unfortunately generating an issue around perception of trust.

The Privacy and Digital Solutions teams at St. Joe’s have been monitoring media coverage, and have been consulting with Zoom directly, as well as partner organizations. Our objective is to understand the real risks and take action where necessary to ensure that both patient and employee privacy and security is protected. While the risks identified are concerning, staff should know that the version of Zoom integrated with Dovetale to support virtual care was carefully reviewed by our Privacy and Security experts and has been configured to minimize risks to patient privacy and system security. Virtual care sessions are never recorded, nor are chat messages retained, so patient information is not stored. Furthermore, St. Joe’s uses a paid version of Zoom carefully configured to maximize protection and avoid the exposures identified in recent articles. The vendor is bound by agreement not to access or use St. Joe’s patient information, and our Virtual Care instance lives on Canadian servers – not U.S. servers. 

Importantly, the Ministry of Health distributed a Zoom Advisory and guidance earlier today (Link: April 9 2020 Cyber Security Advisory - ZOOM), and we can tell you that we exceed the Ministry’s recommendations for ensuring safe use of Zoom.  We will also continue to adjust configurations and update Zoom clients as needed to maintain this protection. Further guidance on how to continue using Zoom in a safe and effective way will follow next week.  

Click here to read more on 'Meetings by Zoom, not conference calls'.