Newsletter

    2nd Quarter WATS NEWS Print

    President's Report

    Hello WATS Members:

    The past couple of months have been very difficult for our country, our economy and our industry.  Our industry is considered ‘essential’, and we must be thankful for that.  However, many of our customers are deemed ‘non-essential’.  The impact among WATS members of the covid19 shutdowns varies tremendously.   As we enter the third quarter of 2020, it looks like businesses will be partially or fully open. And we will be recovering.  Both individual health and business health.   

    Hopefully, you all managed to set time aside to be with your families.  The Covid19 crisis has touched everyone in some ways.   We all have had difficult days.  Including family members who have situations we need to help them with.  Often, we may not take the time for those at home because our hands are full with work.   I encourage everyone to give themselves that time to be with family and have some fun.  Make this a priority!

    WATS is working with Wisconsin Manufacturers and Commerce to help get our economy up and running in a safe and timely manner.  WMC has built a model that will help do this.  They have worked with Senator Kapenga to create a useful model.  It is based on four criteria: Population Density, Infection Rate, Interactive Concentration and Health Care Capacity. Companies would be given a risk factor of minimal, moderate or substantial based on an in-depth analysis of more than 300 NAICS codes and various data points from public health sources.  The higher the risk, the more precautions businesses would be required to take to avoid further spread of COVID-19. Precautions can include, but are not limited to social distancing among employees and customers, operating at reduced capacity, increasing use of personal protective equipment (PPE) and stepping up cleaning procedures.

    Our WATS Brewers game has been postponed for the time being.  Mike is working with the Brewers once Major League Baseball has figured out the scheduling.  We are hoping to be able to reschedule the event.  This may or may not happen based on the proposed plans I have seen so far.  They may be playing without fans at all.  If that were the case Mike will reach out to everyone and refund the payments that have been paid up to date.

    We are very much looking forward to our WATS Fall Conference.  We have a couple of great speakers lined up already.  Former Lieutenant Governor Rebecca Kleefisch and former Green Bay Packer Paul Coffman.  The event will be held September 22nd-23rd at The Edgewater in Madison, WI.  Golf will be held on September 23rd at The Legend of Bergamont.  We hope to see everyone at this great event.

    Please stay safe and healthy during these difficult times.  Please do not hesitate to reach out to us with any questions.

    Jim Leef

    President WATS

     

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    Strategies for Optimizing the Supply of Isolation Gowns

    Audience: These considerations are intended for use by federal, state, and local public health officials; leaders in occupational health services and infection prevention and control programs; and other leaders in healthcare settings who are responsible for developing and implementing policies and procedures for preventing pathogen transmission in healthcare settings.

    Purpose: This document offers a series of strategies or options to optimize supplies of isolation gowns in healthcare settings when there is limited supply. It does not address other aspects of pandemic planning; for those, healthcare facilities can refer to COVID-19 preparedness plans.

    Surge capacity refers to the ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the present capacity of a facility. While there are no widely accepted measurements or triggers to distinguish surge capacity from daily patient care capacity, surge capacity is a useful framework to approach a decreased supply of isolation gowns during the COVID-19 response. Three general strata have been used to describe surge capacity and can be used to prioritize measures to conserve isolation gown supplies along the continuum of care.

    • Conventional capacity: measures consist of providing patient care without any change in daily contemporary practices. This set of measures, consisting of engineering, administrative, and personal protective equipment (PPE) controls should already be implemented in general infection prevention and control plans in healthcare settings.
    • Contingency capacity: measures may change daily standard practices but may not have any significant impact on the care delivered to the patient or the safety of healthcare personnel (HCP). These practices may be used temporarily during periods of expected isolation gown shortages.
    • Crisis capacity: strategies that are not commensurate with standard U.S. standards of care. These measures, or a combination of these measures, may need to be considered during periods of known isolation gown shortages.

    The following contingency and crisis strategies are based upon these assumptions:

    1. Facilities understand their current isolation gown inventory and supply chain
    2. Facilities understand their isolation gown utilization rate
    3. Facilities are in communication with local healthcare coalitions, federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) regarding identification of additional supplies
    4. Facilities have already implemented other engineering and administrative control measures including:
      • Reducing the number of patients going to the hospital or outpatient settings
      • Excluding HCP not directly involved in patient care
      • Reducing face-to-face HCP encounters with patients
      • Excluding visitors to patients with confirmed or suspected COVID-19
      • Cohorting patients and HCP
      • Maximizing use of telemedicine
    5. Facilities have provided HCP with required education and training, including having them demonstrate competency with donning and doffing, with any PPE ensemble that is used to perform job responsibilities, such as provision of patient care

    Conventional Capacity Strategies

    Use isolation gown alternatives that offer equivalent or higher protection.

    Several fluid-resistant and impermeable protective clothing options are available in the marketplace for HCP. These include isolation gowns and surgical gowns. When selecting the most appropriate protective clothing, employers should consider all of the available information on recommended protective clothing, including the potential limitations. Nonsterile, disposable patient isolation gowns, which are used for routine patient care in healthcare settings, are appropriate for use by HCP when caring for patients with suspected or confirmed COVID-19. In times of gown shortages, surgical gowns should be prioritized for surgical and other sterile procedures. Current U.S. guidelines do not require use of gowns that conform to any standards. 

    Contingency Capacity Strategies

    Selectively cancel elective and non-urgent procedures and appointments for which a gown is typically used by HCP.

    Shift gown use towards cloth isolation gowns.

    Reusable (i.e., washable) gowns are typically made of polyester or polyester-cotton fabrics. Gowns made of these fabrics can be safely laundered according to routine procedures and reused. Care should be taken to ensure that HCP do not touch outer surfaces of the gown during care.

    • Laundry operations and personnel may need to be augmented to facilitate additional washing loads and cycles
    • Systems are established to routinely inspect, maintain (e.g., mend a small hole in a gown, replace missing fastening ties), and replace reusable gowns when needed (e.g., when they are thin or ripped)

    Consider the use of coveralls.

    Coveralls typically provide 360-degree protection because they are designed to cover the whole body, including the back and lower legs, and sometimes the head and feet as well. While the material and seam barrier properties are essential for defining the protective level, the coverage provided by the material used in the garment design, as well as certain features including closures, will greatly affect the protective level. HCP unfamiliar with the use of coveralls must be trained and practiced in their use, prior to using during patient care.

    In the United States, the NFPA 1999 standardexternal icon specifies the minimum design, performance, testing, documentation, and certification requirements for new single-use and new multiple-use emergency medical operations protective clothing, including coveralls for HCP.

    Use of expired gowns beyond the manufacturer-designated shelf life for training.

    The majority of isolation gowns do not have a manufacturer-designated shelf life. However, consideration can be made to using gowns that do and are past their manufacturer-designated shelf life. If there is no date available on the gown label or packaging, facilities should contact the manufacturer.

    Use gowns or coveralls conforming to international standards.

    Current guidelines do not require use of gowns that conform to any standards. In times of shortages, healthcare facilities can consider using international gowns and coveralls. Gowns and coveralls that conform to international standards, including with EN 13795 and EN14126, could be reserved for activities that may involve moderate to high amounts of body fluids.

    Crisis Capacity Strategies

    Cancel all elective and non-urgent procedures and appointments for which a gown is typically used by HCP.

    Extended use of isolation gowns.
    Consideration can be made to extend the use of isolation gowns (disposable or cloth) such that the same gown is worn by the same HCP when interacting with more than one patient known to be infected with the same infectious disease when these patients housed in the same location (i.e., COVID-19 patients residing in an isolation cohort). This can be considered only if there are no additional co-infectious diagnoses transmitted by contact (such as Clostridioides difficile) among patients. If the gown becomes visibly soiled, it must be removed and discarded as per usual practicespdf icon.

    Re-use of cloth isolation gowns.
    Disposable gowns are not typically amenable to being doffed and re-used because the ties and fasteners typically break during doffing. Cloth isolation gowns could potentially be untied and retied and could be considered for re-use without laundering in between.

    In a situation where the gown is being used as part of standard precautions to protect HCP from a splash, the risk of re-using a non-visibly soiled cloth isolation gown may be lower. However, for care of patients with suspected or confirmed COVID-19, HCP risk from re-use of cloth isolation gowns without laundering among (1) single HCP caring for multiple patients using one gown or (2) among multiple HCP sharing one gown is unclear. The goal of this strategy is to minimize exposures to HCP and not necessarily prevent transmission between patients. Any gown that becomes visibly soiled during patient care should be disposed of and cleaned.

    Prioritize gowns.
    Gowns should be prioritized for the following activities:

    • During care activities where splashes and sprays are anticipated, which typically includes aerosol generating procedures
    • During the following high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of healthcare providers, such as:
      • Dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, wound care

    Surgical gowns should be prioritized for surgical and other sterile procedures. Facilities may consider suspending use of gowns for endemic multidrug resistant organisms (e.g., MRSA, VRE, ESBL-producing organisms).

    WHEN NO GOWNS ARE AVAILABLE

    Consider using gown alternatives that have not been evaluated as effective.

    In situation of severely limited or no available isolation gowns, the following pieces of clothing can be considered as a last resort for care of COVID-19 patients as single use. However, none of these options can be considered PPE, since their capability to protect HCP is unknown. Preferable features include long sleeves and closures (snaps, buttons) that can be fastened and secured.

    • Disposable laboratory coats
    • Reusable (washable) patient gowns
    • Reusable (washable) laboratory coats
    • Disposable aprons
    • Combinations of clothing: Combinations of pieces of clothing can be considered for activities that may involve body fluids and when there are no gowns available:
      • Long sleeve aprons in combination with long sleeve patient gowns or laboratory coats
      • Open back gowns with long sleeve patient gowns or laboratory coats
      • Sleeve covers in combination with aprons and long sleeve patient gowns or laboratory coats

    Reusable patient gowns and lab coats can be safely laundered according to routine procedures.

    • Laundry operations and personnel may need to be augmented to facilitate additional washing loads and cycles
    • Systems are established to routinely inspect, maintain (e.g., mend a small hole in a gown, replace missing fastening ties) and replace reusable gowns when needed (e.g., when they are thin or ripped)

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    TRSA Urges U.S. Governors to Strengthen Restaurant Safety – Operators Need to Mobilize!


    Maximizing restaurants’ hygiene requires more of them to adopt a cleanliness practice of outsourcing their supply of expertly laundered tablecloths, garments and other textiles and products that keep these facilities clean. TRSA is calling on the National Governors Association (NGA) today to prompt states to feature linen, uniform and facility services in guidance documents for restaurants as they reopen amid the current COVID-19 environment.

    To this end, TRSA is advancing an advocacy and publicity campaign to prompt restaurants reopening during the COVID-19 pandemic to maximize hygiene through linen and uniform services. The campaign is being kicked off with a request to each respective governor through the NGA to guide these facilities accordingly (click here to see the letter). The campaign will continue in the upcoming weeks with communications to restaurants and consumers emphasizing the utility and value of expertly laundered and serviced tablecloths, garments and other textiles and products.

    TRSA also is supplying a letter for operators to send to their respective governors and state health officials. Click here (TRSA Restaurant Safety Guidance) for a copy of a letter to download, place on company letterhead and send to the appropriate offices. Members are also encouraged to download the letter from TRSA President & CEO Joseph Ricci to Larry Hogan, chairman of the National Governors Association, for use in their own correspondence to restaurateurs. The letter also can be used to send to your local newspaper and other news outlets.

    More details about the campaign will be covered online in the TRSA Weekly Industry Update webinar at 11:30 a.m. EDT on Thursday, April 30. Click here to register for this program, which will include guest presenters Ben Fox, senior marketing manager, Alsco Inc.; and Charles Crowell, director of strategy, Milliken & Co., sharing their observations of restaurant reopenings.

    The letter notes that bacteria have been shown to be present in excessive amounts on bare restaurant tables, even with regular cleaning, in comparison with tablecloths. Bare tables can be a breeding ground for all types of microscopic bacteria. Tablecloths can provide a five-times-cleaner surface and are touched only at the corners by the server laying the cloth and by the immediate patrons.

    TRSA member best-management practices help keep the dining public safe by raising restaurant cleanliness standards and inspiring public confidence, Ricci points out, identifying the following as practices that should be standards for any guidance released to restaurants and dining establishments for reopening:

    • Hygienically clean tablecloths, placemats and napkins should be used to reduce or eliminate disease transmission by touch. Replacing tablecloths each time new guests are seated ensures a clean and safe table. These products can also identify the tables to be used for social separation. Placemats can accomplish a similar result by seating guests further apart at the same table or counter. Hygienically Clean commercial laundry certification standards minimize contamination risk.
    • Staff should be given hygienically cleaned, commercially laundered uniforms daily such as chef coats, cook shirts, pants and aprons to wear throughout their shifts. This applies to takeout and delivery staff, as well as kitchen and wait staff. Research verifies the superior cleanliness and public preference for professional laundering of work uniforms. They should not be washed at home. Instead, they should be left in a bin at the restaurant to be picked up and commercially laundered. A clean uniform should be given out at the start of each employee’s shift, replacing the clothes in which they commuted to the restaurant.
    • Hand-sanitizer dispensers should be placed throughout restaurants for guests and staff to use.
    • Reusable/washable face masks that meet U.S. Centers for Disease Control and Prevention (CDC) guidelines and disposable gloves should be worn by staff. Gloves should be changed out often throughout an employee’s shift.
    • Commercial cleaning solutions should be used on all hard surfaces throughout the day, including entryway door handles, kitchen areas and bathrooms.

    TRSA is developing a guidance document and “explainer” animation for restaurants to optimize their use of linen, uniform and facility services to maximize facility hygiene. Animation that will prompt diners to recognize a restaurant’s use of such services also is in the works. Publicity placement in foodservice industry and consumer media is anticipated with social media advertising support.

    “As America starts to get back to business and dining establishments begin to reopen, providing the public with clean and safe dining establishments will be a key part of an economic recovery,” Ricci said. “Teaching and requiring restaurants to abide by these steps should be a cornerstone of this process.”

    Now is the time for TRSA members to act! Click here to download the restaurant safety guidance letter to send to your respective governor and state health officials, as well as local news outlets.

    Article provided by TRSA


     

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    WMC Back to Business Plan

    Wisconsin is ready to get back to business. Much of the state’s economy has been shut down since March 25, when Gov. Tony Evers’ Safer at Home order went into effect. At the time, the governor took swift action to protect the lives of Wisconsinites. The time-frame was meant to cover two 14-day incubation periods to drastically slow the spread of COVID-19. With the governor’s initial Safer at Home order expiring at 8AM on April 24, it is now time to also protect livelihoods.

    To do this, Wisconsin Manufacturers & Commerce (WMC) – the combined state chamber, manufacturers’ association and safety council – is releasing this plan to get Back to Business. It is designed to strategically open Wisconsin businesses based on a number of risk factors and offers employers a clear vision for when and how they can begin to operate, once again.

    The Back to Business plan was developed with input from a diverse group of stakeholders, including those in business, government and the medical community. Additionally, it draws on best practices and recommendations from the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control (CDC).

    How it works

    Under the Back to Business plan, the Wisconsin Department of Health Services (DHS) would provide a simple-to-use form on their website based on the Back to Business model. To determine what steps are needed to reopen, a business would enter three things:

    • Company Name
    • Wisconsin County
    • NAICS Code

    After submitting the form, the platform would automatically use four factors to determine the level of risk for that specific company:

    • Local Infection Rate in County of Operation
    • Population Density of County of Operation
    • Interactive Concentration (Based on NAICS Code Business Sector)
    • Health Care Capacity/Utilization in County of Operation 

    Companies would be given a risk factor of minimal, moderate or substantial based on an in-depth analysis of more than 300 NAICS codes and various data points from public health sources.

    The higher the risk, the more precautions businesses would be required to take to avoid further spread of COVID-19. Precautions can include, but are not limited to social distancing among employees and customers, operating at reduced capacity, increasing use of personal protective equipment (PPE) and stepping up cleaning procedures.

    This plan calls for Wisconsin to get Back to Business on Monday, May 4 under the guidelines proposed.

    This will give businesses time to recall furloughed employees, contact suppliers and take other necessary steps to open their doors. It will also give DHS and other government agencies time to build, test and launch the portal necessary for businesses to determine their risk level. With the health of Wisconsin’s residents and economy in mind, a bipartisan approach to implement this plan could get the state back on the road to recovery.

    Now is the time to protect lives, livelihoods and Wisconsin’s future. Let’s get Back to Business.


     

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