SAC Patient Receiving from COVID+ Household

(excerpt from VTH Policy #Phand910 – COVID-19 Exposed Patient Handling)

Purpose/ Applicability: 
The purpose of this SOP is to describe the procedure for receiving small animal patients from COVID+ homes into the Small Animal Clinic (SAC) during the COVID-19 pandemic.

Scope:
The VTH and its clinical personnel will provide care to patients owned by persons with suspected or confirmed COVID-19 positive status. However, every available precaution will be taken to ensure that patient care can be done in a manner that is safe for VTH personnel.Faculty on service should be notified immediately if there is a patient arriving to the VTH from a COVID + home. 
The appropriate screening questions via the initial telephone call to the hospital should prepare the staff for the patient’s arrival.

Definitions:

•PPE – personal protective equipment including biohazard suit, face mask or shield, gloves.
•High Risk for COVID-19 – A person having clinical signs associated with corona virus infection including fever, cough, or respiratory distress; a person who has tested positive for COVID-19 in the last 14 days; or a person who has close direct contact with another person having signs or positive test.

Equipment:
• Gurney
• PPE – gloves, mask, biohazard suit, face shield, 
• Scale
• Sanitizer – dilute bleach solution or Rescue- Accelerated Hydrogen Peroxide, one-step germicidal disinfectant cleaner and deodorant (0.5% hydrogen peroxide) in spray bottle or mop with bucket

Procedure:

Patient arrival to the Veterinary Teaching Hospital (VTH): 

1. Client Services will ask pre-screening questions of clients arriving at the VTH to determine if they are a high risk for COVID-19 exposure.
2. After the initial screening phone call from the owner, a Client Services staff member or the person taking the phone call should alert the clinical staff that the patient has arrived and the COVID+ status of the household. 
   a. No VTH personnel should interact with persons from a COVID + household without appropriate PPE. Training videos regarding donning and doffing PPE are available at https://vetmed.illinois.edu/intranet-safety/training/ and should be reviewed prior to patient visit.
3. Anyone who is to retrieve a patient from a COVID + home should wear a full-body biohazard suit (bunny suit), N95 mask if available or surgical mask if N95 mask is not available, goggles or eyeglasses +/- face shield, and exam gloves. 
   a. These can be found in the small animal isolation unit.
   b. Face shields are available and may be worn under high risk circumstances.
   c. Hand-washing should occur before donning gloves, and again after doffing gloves. 
4. Request that an owner wear a mask prior to your interaction if they are not already wearing one. Disposable masks are available at LAC/SAC/VMSC admissions desks. 
5. Limit contact time with the owner to less than 5 minutes and maintain social distance of 6 feet or more when interacting with the client. 
6. If interaction closer than 6 feet is required, minimize contact and wash your hands afterwards. Do not touch your face, nose, eyes or mouth.

Admitting patient to VTH

1. The employee should inform the client that paperwork will be signed via verbal consent over the phone. Consent for treatment must be obtained and should include a code status and estimate sheet when the patient is admitted to the hospital. 
2. No personal effects from patients are allowed into the VTH. 
3. Use a gurney to transport animals into the VTH whenever practical.
4. For Dogs: 
   • The owner should remove any collar, leash, harness, or scarf from patients, and keep these items with the owner.
   • The owner should place a VTH slip lead on their dog and remove the dog from the vehicle themselves. The slip lead should be dedicated to this patient until discharge. The leash should be disposed of in a biohazard waste container once the patient has been discharged.
   • Once the dog is out of the car, take control of the slip lead and place the dog on the gurney if possible. If using a gurney is not possible or would present a danger to the patient or staff member, the dog may be walked into the VTH
5. For Cats or Ferrets:
   • The owner should remove any collar or harness from the patient and place the patient into a VTH pet carrier dedicated to the COVID exam space. If the pet is in the owner’s carrier and cannot be moved safely into a VTH carrier, the pet may be transported into the VTH in the owner’s carrier but the carrier will be returned to the owner immediately after transferring the patient to a VTH cage.
6. The designated triage location for animals from COVID + homes is the MRO Exam Room (SAC 140). 
7. The patient should be brought directly into the VTH and into the MRO Exam Room.
8. An assistant wearing the appropriate PPE (as defined above) should open the VTH door and the exam room door.
9. An emergency crash cart and oxygen supply source will be maintained in the MRO Exam Room for use when needed. 
10. The weight scales located in the MRO Exam Room should be used to weigh these patients. 
11. The gurney, door handles, the scale and any other object that came into contact with the owner or animal, as well as the floor traversed by the patient (if the animal was walked) should be disinfected immediately following patient admission using a dilute bleach or Rescue solution.

Patient Triage 

1. The patient should be triaged as any other patient, but handling of the patient should be minimized if possible. Limit the number of people to handle the patient while also maintaining standard of care. 
2. Animals showing clinical signs associated with COVID-19 infection, including fever, cough, or lower respiratory signs, may be tested at clinician discretion and submitted to the VDL. Results generally are available within 24 hrs.
3. Patients from COVID + households are allowed in the VTH clinical areas, unless the patient has a disease that warrants housing them in isolation. In that case, isolation ward protocols should be followed, including taking precautions when moving the animal to other areas of the VTH.
4. Any sensitive equipment used in the triage and diagnostic plan for the patient should be disinfected with alcohol. Other equipment or supplies should be disinfected using a dilute bleach or Rescue solution. 

Patient Hospitalization and In-Patient Management

1. Animals from COVID + homes WITH signs of infectious respiratory disease should be housed in designated cages in the Isolation Ward treatment room. Isolation Ward protocols will be followed.
     a. Personnel working with animals with an illness that IS suspicious of COVID-19 infection will wear face masks and eye protection, and/or face shield, gloves and protective outerwear (biohazard suit or designated gown)
   
   
2. Animals from COVID + homes WITHOUT signs of infectious respiratory disease should be housed in ICU if intensive care is required or in designated cages at the south end of the MRO ward if general hospitalization is required. When possible, cats should not be housed in cages in directly adjacent to other cats.
     a. Personnel working with animals not suspected to have COVID-19 infection, but from a COVID + household, should wear face masks and gloves.

Patient Discharge from VTH

1. When discharging the patient from the VTH to the owner, appropriate PPE (described above in patient arrival) should be worn by personnel interacting with the owners.
2. Dogs should be walked securely tethered using a VTH slip lead and transferred directly to the owner’s control, keeping the slip lead with the animal. Dogs that can’t walk may be transported to the owner on a gurney. The owner will take control of the patient off the gurney. 
3. Cats and ferrets should be transported to the owner in the isolation designated pet carrier. The owner should remove the patient from the carrier and take control of the patient directly.
4. Once the patient is discharged, any equipment that was used for patient care should be disinfected (as previously described) and returned to its proper location.
5. PPE should be doffed and discarded into an appropriate biohazard receptacle.
6. Contact the Animal Caretakers to perform room/cage disinfection.

Patient Euthanasia in VTH with Owner Present

1. If a patient is to be euthanized, arrangement for payment and disposal of remains should occur prior to the procedure.
2. For euthanasia, an owner may be allowed into the VTH. The owner will be required to wear a face mask to cover their nose and mouth, and one will be provided for them if necessary. 
3. Prepare the patient for euthanasia including placement of an IV catheter and sedation if necessary. 
4. Bring necessary equipment to the designated room (exam room, Molly’s room, etc.) where euthanasia will be performed. No community work area (ICU, ER ward, etc.) where other personnel are present will be used for this purpose even if moving the patient from these areas is detrimental to patient well-being.
5. Move the patient to the designated room and have an assistant monitor the patient.
6. Don appropriate PPE as previously described and escort the owner to a designated room while maintaining a distance of 6 feet or more from the owner.
   • The owner may be provided time alone with the patient if safe to do so.
7. Euthanasia is then performed. 
   • A 6 foot distance from the owner may be achieved by attaching 2 extra IV extensions prior to administration of euthanasia solution, followed by an appropriate volume of flush solution to ensure administration of the appropriate dose. Do not come in contact with an owner’s secretions. 
8. Following euthanasia, the owner should be escorted from the VTH and any further communication be done by phone. 
9. Doff the PPE and dispose of in a biohazard receptacle.
10. Using new PPE, disinfect any equipment (as previously described) that was placed in the room prior to the euthanasia and return it to the proper location.
11. Close the room to further patient use and contact the Animal Caretakers to perform room disinfection.

General

• Any person at risk or who is unable to participate in any step of the processes defined in this policy should self-identify to the senior staff on clinics. This may be done in a confidential manner and every effort will be made to allow the staff member to assist in ways that do not involve direct contact with the owners or patient from a COVID + household.
• Remember to wash your hands, do not touch your mouth, nose, face or eyes, and maintain a social distance of 6 feet or more from anyone. Wear face masks at all times in the VTH when in community areas or around other personnel. 
• For any questions regarding protocol or procedures, please contact the ECC faculty on service. 
• If concern that this protocol is not being followed or does not meet the needs of the VTH, please contact the ECC faculty on service. 
• If outside consultation is required, the ECC faculty on service or the VTH Director will contact the Champaign County Health Department or Carle Hospital regarding questions about risk assessment for staff.