801 DB# 1 WK 6 Post # 1: What would you do if you were the in-charge of this ED?

801 DB# 1 WK 6 Post # 1: What would you do if you were the in-charge of this ED?
A Sample Answer For the Assignment: 801 DB# 1 WK 6 Post # 1: What would you do if you were the in-charge of this ED?
Title: 801 DB# 1 WK 6 Post # 1: What would you do if you were the in-charge of this ED?
801 DB# 1 WK 6 Post # 1: What would you do if you were the in-charge of this ED?
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 What would you do if you were the in-charge of this ED?
801 RESPONSES D B#1  Heng Lin – Thursday, 16 February 2023, 11:54 AMHealthcare facilities must create centralized and highly monitored storage rooms or warehouses to secure PPE supplies. For example, one of the biggest problems during the Covid-19 pandemic was the shortage of PPE supplies. When covid hit the world, nobody was ready, and everyone was panicking about getting PPE supplies. People are selfish, and this is just human nature. As a result, many healthcare workers took the PPE supplies home for their family and friends. Sure, we all understand the reason behind the action, but what if everyone was doing the same thing? Let’s take N95 masks as an example. What if everyone who worked in the hospital took the PPE supplies without asking? If there is no centralized monitoring system, who knows you are taking it? Especially if the world were in the middle of the pandemic, people would not care about taking a couple of extra N95 masks so their family and friends could be safe. This is why healthcare facilities must create centralized and highly monitored storage rooms so that people can not just take whatever they want during the pandemic. By creating a centralized and highly monitored storage unit, the PPE supplies will not only be safe, but the facilities will also be able to allocate the right resources in the right places.802 DB 1Interpersonal Communicationby Betty Hayes – Thursday, 16 February 2023, 11:51 PMInterpersonal CommunicationTrust is indeed a critical factor for successful collaboration and cooperation in any team. When trust is present, it triggers a sequence of steps that promotes the oneness of the company. The first step that enhances strut is diversity appreciation and cultural competencies. Trust is the foundation for appreciating and respecting diversity. When team members trust each other, they are more open to learning about different cultures, backgrounds, and perspectives (Ivan, 2022). This leads to greater cultural competence, which is the ability to work effectively with people from diverse backgrounds. Secondly, trust leads to the development of interpersonal communication. When team members trust each other, they are free with one another, which helps them talk openly, honestly, and constructively. They are also more willing to listen to others’ perspectives and ideas, which leads to better collaboration and problem-solving (Ivan, 2022). Moreover, it helps develop good work relationships as individuals can build strong relationships in any team. Trust leads to loyalty and increased job satisfaction. In this case, when team members trust their colleagues and managers, they are more likely to feel valued, respected, and supported. This leads to greater job satisfaction and a stronger commitment to the organization. Moreover, there is an increased commitment where team members feel a sense of belonging and a shared purpose. This leads to greater commitment to the team’s goals and the organization’s mission. Trust leads to more productivity (Ivan, 2022). This is because teams are more likely to work together efficiently and effectively. They are also more willing to take risks and try new ideas, which leads to innovation and improved performance. All these lead to organizational success. Trust is the foundation for achieving organizational success. When colleagues trust each other, they believe in togetherness and work towards achieving the same goals and results. This creates a positive work environment, which attracts and retains top talent, increases customer satisfaction, and ultimately leads to the organization’s success.802 DB 2Discussion Post #1: Trust Me – Kizito Uzoma Ndugbuby Kizito Ndugbu – Wednesday, 15 February 2023, 11:38 PMTrust plays a crucial role in the success of an organization by creating a positive and supportive environment that fosters collaboration and communication. When trust exists within an organization, it can trigger a sequence of steps that can lead to success.As in Figure 4.1, we see how interpersonal communication in the form of trust can motivate and sustain organizational success, productivity, loyalty, job satisfaction, commitment, and work relationships, as it fosters cultural competence and appreciates diversity.First, trusting relationships between employees and their supervisors lead to increased employee engagement and motivation. Employees who trust their superiors are more likely to feel valued and invested in their work, which can increase their productivity.Also, trust enables open and honest communication, allowing for the free flow of ideas and constructive criticism. This can lead to better decision-making, problem-solving, and overall teamwork. When employees trust each other and their leaders, they are more likely to take calculated risks and experiment with new ideas. This can lead to innovation and continuous improvement.Again, trust fosters collaboration by creating a supportive environment where employees are willing to share their ideas and work together. This can lead to increased creativity and more effective problem-solving.Furthermore, a culture of trust can lead to increased employee satisfaction, reduced turnover, and improved morale. When employees feel trusted, they are more likely to be loyal and committed to the organization.
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID19. The COVID-19 resource centre is hosted on Elsevier Connect, the company’s public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre – including this research content – immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. JID: YMDA ARTICLE IN PRESS [mUS1Ga;August 12, 2020;17:6] Disease-a-Month xxx (xxxx) xxx Contents lists available at ScienceDirect Disease-a-Month journal homepage: www.elsevier.com/locate/disamonth COVID – 19 case study in emergency medicine preparedness and response: from personal protective equipment to delivery of care Brenna Leiker, MS, PA-C, Katherine Wise, MSN, APN-CNP∗ NorthShore University HealthSystem, Jane R Perlman NP/PA Fellows 2019-2020, Division of Emergency Medicine, Evanston, IL, United States “May you live in interesting times”.English expression of Purported Chinese Curse Introduction In late 2019, a novel new virus appeared in China with reports of a cluster of pneumonia cases in the large city of Wuhan. Current epidemiological theories trace the virus’s first appearance to a seafood market in the city. It is there the virus was thought to have passed from animals to humans. Hundreds and then thousands of Chinese nationals developed high fevers, body aches, and pneumonia-like symptoms. Testing to determine cause revealed it wasn’t SARS, the coronavirus that spread around the country in 2002, or the deadly Middle East Respiratory Syndrome, MERS; nor was it influenza, bird flu, or the adenoviruses that cause respiratory symptoms.49 All this was unfolding just before China’s biggest holiday, Spring Festival, a time when hundreds of millions of Chinese travel to celebrate and be with family.20 Over the ensuing months, this new coronavirus spread across the globe. By February 11, 2020, this virus was given an official name severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) by the International Committee on Taxonomy of Viruses. On that day the World Health Organization announced the official name of the virus, there were 42,708 confirmed cases reported in China and 1017 deaths in that country, mostly in Wuhan’s Hubei province. Outside of China, there were 393 reported cases in 24 countries and 1 death.69 In the months following that day, many millions have gotten sick and hundreds of thousands have died. As for nomenclature, the illness that this virus causes became synonymous with the virus itself: COVID 19. ∗ Corresponding author. E-mail addresses: kwise@northshore.org, bleiker@northshore.org (K. Wise). https://doi.org/10.1016/j.disamonth.2020.101060 0011-5029/© 2020 Elsevier Inc. All rights reserved. Please cite this article as: B. Leiker and K. Wise, COVID – 19 case study in emergency medicine preparedness and response: from personal protective equipment to delivery of care, Disease-a-Month, https://doi.org/10.1016/j.disamonth. 2020.101060 JID: YMDA 2 ARTICLE IN PRESS [mUS1Ga;August 12, 2020;17:6] B. Leiker and K. Wise / Disease-a-Month xxx (xxxx) xxx In the United States, the first COVID case was reported on January 21, 2020.31 In the weeks that followed, an additional 53 cases were reported and many public health officials hoped the viral spread was limited but containment measures were haphazard and based on a rapidly developing knowledge base about viral transmission. The federal government barred entry of most foreign nationals with recent travel to China, but not US residents who had been to China. Little viral testing was available or done to screen people entering the US. Given low official numbers of cases that month, social gatherings were not restricted. Voluntary self-quarantine measures and hand hygiene recommendations were the mainstays of response at that time.42 By late February, reports of positive cases outside of China with no recent travel history indicated a rise in community transmission and hinted at pandemic spread. Cruise ships were particularly vulnerable to the spread of COVID with their crowded common areas, travel to new areas, and limited medical resources.53 Italy and Iran were also seeing a rapid increase in cases, foreshadowing the effects of widespread transmission and prompting concerns over upcoming holiday and religious pilgrimage travel.32 On February 29th, authorities in Seattle reported the first American death from COVID; later reports indicated the earliest COVID death in the United States was in early February in Santa Clara County in the San Francisco Bay area.66 Ongoing community spread, attendance at professional and social events, introduction into facilities and settings prone to amplification, and the lack of viral testing contributed to rapid increase in transmission in March in the United States. Large social events such as Mardi Gras, spring break vacation travels, and attendance at international professional conferences were held as planned. Directly linked increases in cases related to events like these prompted state-led restrictions in gatherings and travel.6 A funeral in Albany, Georgia was attended by more than 100 people. Later, Dougherty County, Georgia, the small rural county that includes Albany, reported the highest cumulative incidence of COVID (1630/10 0,0 0 0) in the country at the time.65 Areas particularly impacted at this time were longterm care facilities and high-density urban areas. Other factors increasing COVID spread included confluence with influenza and pneumonia season, continued importation of virus from other areas via travel, and undetected transmission among presymptomatic or asymptomatic individuals. By mid-March, transmission had become widespread and state and federally mandated measures to contain spread and protect health care capacity were initiated. Federal travel bans expanded to include Italy, South Korea and many European countries. Nearly all states were under some form of stay-at-home orders with closures of school and nonessential workplaces and cancellation of sporting events and all group gatherings to try to “flatten the curve.” Most lockdowns began between late March and early April. California was the first state to issue lockdown orders on March 19th, following the lead of San Francisco three days prior.58 Restrictions on international travel were put in place, and a No Sail Order from the Director of the CDC was issued on March 14th, suspending travel on US waters.65 On March 26th, the United States became the country hardest hit in the world by coronavirus with 81,321 confirmed infections.51 That trend continues today. COVID in Illinois Spread of coronavirus and the challenges inherent in pandemic circumstances were similar in the state of Illinois. Its index case was the second detected case in the United States: a woman traveling from Wuhan, China in mid-January who returned home to Illinois and was hospitalized a week later with pneumonia.7 Her spouse tested positive as well the following week which was the first recorded case of local transmission in the United States.26 Early screening and positive cases in Illinois were connected to travel histories such as recent travel to high risk areas as with Illinois’ first case or recent travel on a cruise ship.36 Nationally, retrospective analysis of surveillance data from this time period suggests that limited community transmission likely began by early February after initial importation from travelers from China and Europe.43 This could not be tracked until late February to early March via emergency department syndromic surveillance data as evidenced by an increase in emergency Please cite this article as: B. Leiker and K. Wise, COVID – 19 case study in emergency medicine preparedness and response: from personal protective equipment to delivery of care, Disease-a-Month, https://doi.org/10.1016/j.disamonth. 2020.101060 JID: YMDA ARTICLE IN PRESS B. Leiker and K. Wise / Disease-a-Month xxx (xxxx) xxx [mUS1Ga;August 12, 2020;17:6] 3 Fig. 1. Percentage of emergency department (ED) visits for COVID-19–like illness (CLI),∗ in 14 counties†,§ (three in California and Washington [A]; four in Illinois, Louisiana, Massachusetts, and Michigan [B]; and seven in New York [C]) — National Syndromic Surveillance System,¶ February 1–April 7, 2020. Source: https://www.cdc.gov/mmwr/volumes/69/wr/ mm6922e1.htm?s_cid=mm6922e1_w#F1_down Legend: Abbreviation: COVID-19 = coronavirus disease 2019. ∗ Fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnostic code. † California: Santa Clara County; Washington: King County, Snohomish County; Illinois: Cook County; Louisiana: Orleans Parish; Massachusetts: Middlesex County; Michigan: Wayne County; New York: Bronx County, Kings County, Nassau County, New York County, Richmond County, Queens County, Westchester County. § King County, Washington includes Seattle; Cook County, Illinois includes Chicago and many of its suburbs; Wayne County, Michigan includes Detroit and many of its suburbs; Orleans Parish includes New Orleans; Kings County (Brooklyn), Queens County (Queens), Bronx County (Bronx), Richmond County (Staten Island), and New York County (Manhattan) are all within New York City. ¶ From the subset of emergency departments in each county that participates in the National Syndromic Surveillance Program. department visits for COVID-like illness demonstrated increased incidence (Fig. 1). This data represents a critical indicator, given limitations in widespread testing at that time. By March 10th, the first cases of coronavirus were being reported not only outside Cook County but also in individuals with no identifiable risk factors such as recent travel or known sick contacts.37 Retrospective analyses have confirmed the deadly nature of community transmission like the above case in Albany, Georgia: Chicago Department of Public Health (CDPH) investigated a large, multi-family cluster of COVID positives and presumed positive cases. This cluster investigation and tracing demonstrated transmission to non-household contacts and family gatherings after one index patient attended funeral events that triggered a chain of transmission that included 15 other confirmed and probable cases of COVID and ultimately three deaths.25 Please cite this article as: B. Leiker and K. Wise, COVID – 19 case study in emergency medicine preparedness and response: from personal protective equipment to delivery of care, Disease-a-Month, https://doi.org/10.1016/j.disamonth. 2020.101060 JID: YMDA 4 ARTICLE IN PRESS [mUS1Ga;August 12, 2020;17:6] B. Leiker and K. Wise / Disease-a-Month xxx (xxxx) xxx Long term care facilities (LTCF) became a particular area of focus and monitoring. The first resident of an Illinois long term care facility that tested positive during this time spurred testing of the entire facility and resulted in 21 positive cases including 17 residents and 4 staff members, confirming the fears of public health officials both of the inherent risky nature of congregate living and the vulnerability of congregate living residents.38 Increased guidance from IDPH for nursing homes included restrictions on all visitors, volunteers, and non-essential health care personnel (e.g., barbers), cancellation of group activities and communal dining, and active symptom monitoring for both residents and staff. As one congregate living resident summarized during his emergency room visit at the time: “I haven’t been allowed to leave my room and they bring all my meals to my door and leave it there. My family can’t visit me.” By the time that Illinois Governor Pritzker issued stay-at-home orders on March 21st, Illinois had 585 confirmed cases across 25 counties, including 163 recently diagnosed new cases and a death toll of five.39 The directive prohibited socializing in-person with people outside your household and gatherings larger than 10 people. Playgrounds were closed and selective green spaces were used with 6 feet of social distancing. Only essential travel was permitted and essential services continued. At the time, Illinois was joining California, New York and Connecticut, states with three of the largest cities in the country, to enforce strict sheltering measures. Illinois remains one the states with stricter sheltering measures in the country and subsequent reopening guidelines currently. COVID in the emergency department The approach to the coronavirus pandemic in our emergency department focused on identification and isolation of infected individuals, adequate protection of staff, reporting of positive cases to the health department, effective treatment, and education of patients and families. Protocols for triaging, use of PPE (personal protective equipment), environmental services and cleaning, even the types of tests we ordered were adjusted to maximize protection. Use of telemedicine technologies helped mitigate risk and exposure. Care for these patients was pared down to the most essential personnel to minimize staff exposure, especially given a worst case scenario that predicted temporary loss of staff due to illness and quarantining. Staff was reallocated to essential areas such as the ED, ICU, home health, and nursing homes to help test and care for COVID patients. Other staff were recruited from outpatient areas with less volume to assist in the ED in anticipation of higher volumes and unanticipated staff absences due to illness. The physical space of the emergency room was re-evaluated to best triage and isolate COVID patients. Protocols for cleaning and sanitizing rooms and common diagnostic areas (radiology, CT scanners) were formulated to balance the need to turnover spaces efficiently but safely. A trauma or stroke patient cannot be imaged in a CT scanner that just minutes before accommodated a confirmed COVID positive patient, so protocol for use and cleaning had to be developed. These were but a few of the many challenges that pandemic conditions present to an emergency room and to a hospital. The NorthShore University HealthSystem (NorthShore) had to be dynamic, informed, and innovative in its approach in order to provide effective care with minimal risk of exposure to both patients and staff. NorthShore is headquartered in Evanston, IL and includes 5 hospitals– Evanston, Skokie, Glenbrook, Highland Park and Swedish–on the north side of Chicago and its suburbs. These ED’s are busy–seeing a combined total of over 170,0 0 0 visits annually.34 The integrated nature of the hospital system means that NorthShore can be dynamic and responsive to the needs of the community while also having the resources to be effective. Advanced Practice Practitioner (APPs) is a term used to represent Physician Assistants and Nurse Practitioners. APP’s have traditionally been widely used in the NorthShore system and are utilized in a variety of clinical areas from outpatient to inpatient roles. APP’s are used in nearly every service area, evaluating patients, ordering tests, formulating treatment plans, and educating and advising patients and families. The NorthShore ED APP group consists of 31 fullPlease cite this article as: B. Leiker and K. Wise, COVID – 19 case study in emergency medicine preparedness and response: from personal protective equipment to delivery of care, Disease-a-Month, https://doi.org/10.1016/j.disamonth. 2020.101060 JID: YMDA ARTICLE IN PRESS B. Leiker and K. Wise / Disease-a-Month xxx (xxxx) xxx [mUS1Ga;August 12, 2020;17:6] 5 time, part-time, and resource team APP’s. We work all the ED pavilions in both fast track and main room areas. APP’s assist by seeing patients alongside and in addition to the physicians, dispersing responsibilities and providing more complete care. With the advent of COVID, we have worked to adjust our role along with the rest of the ER team. APP’s within NorthShore have had to alter their usual role to adapt to COVID, many temporarily relocating to the ED, Immediate Care, inpatient floor, ICU, and as part of the nursing home testing outreach team. APP’s who participated in these roles were able to alleviate the demand placed on these departments and provide access to on-site testing. APP’s in the Immediate Cares have played a crucial part in caring for COVID patients and providing access to testing within their clinical sites. APP’s in the ICU have been critical in helping fill the gaps where additional staff where needed to care for COVID patients, make calls to update family members, and provide input for treatment protocols. We, the authors of this article, work as APP’s within the NorthShore emergency department. The following is a detailed description of our perspective on how NorthShore, one hospital system in the US, adapted to respond to the demands of the COVID pandemic. In writing this paper, we interviewed people across the system to help capture some of the changes our hospital system underwent to respond to COVID. Hospital communication during COVID Communication throughout the COVID response faced many challenges and growing pains. The landscape of understanding and response to the virus changed so radically over this year that clear and constant communication was vital for healthcare workers. Challenges arose with social distancing and sheltering at home guidelines restricting large meetings that posed a threat of transmission,yet it was essential to maintain a clear understanding of clinical and operational guidelines to ensure safe and effective care. These efforts occurred on many levels. Early on, NorthShore set up an online COVID resource center to update staff. The site was divided into protocols, updates, and specific service line guidelines (such as surgery, vascular lab, or psychiatry admissions). Also included in updates and education were common procedures performed in caring for COVID patients such as intubation, donning and doffing protocols, updated testing guidelines, and proper nasopharyngeal swabbing technique. NorthShore’s internal COVID website also included the most recent recording of the weekly physician update for the hospital system. These meetings were conducted by COVID response team leaders in the NorthShore system who drew on their expertise in their clinical areas to update and educate physicians across the system and other NorthShore employees on particular aspects of COVID and NorthShore’s response to the pandemic. Representatives included NorthShore’s leaders including Dr. Mahalakshmi Halasyamani, Chief Quality and Transformation Officer, Dr. Tom Hensing, Chief Quality Officer, and Dr. Kamaljit Singh, Director of Microbiology and Infectious Diseases Research. Each offered updates including testing and laboratory data, hospital protocols, and clinical research trials. The weekly meeting also offered a forum for addressing meeting attendees’ questions, some of which were particular to their own specialty but also arose from general curiosity about NorthShore’s COVID response. NorthShore’s CART (COVID Analytics Research Team) maintained a real time data resource accessible through Epic, NorthShore’s electronic medical record system. This page included current operational COVID census within the hospital system as well as total testing outcomes. Through the hard work of this team, data was analyzed by age, end outcome, and other markers. More recently, CART has begun analyzing and presenting early data from NorthShore’s COVID antibody testing. Within the ED, our division chief Dr. Ernest Wang hosted bi-weekly call-in meetings open to physicians, APP’s, nurses and ED staff. Those meetings focused on ED workflow and covered a variety of topics. He also invited feedback and discussion as well as contributions from directors of each of the individual ER locations. Given the information deluge that has characterized COVID, physicians in our group worked hard to stay up-to-date themselves and shared important Please cite this article as: B. Leiker and K. Wise, COVID – 19 case study in emergency medicine preparedness and response: from personal protective equipment to delivery of care, Disease-a-Month, https://doi.org/10.1016/j.disamonth. 2020.101060 JID: YMDA 6 ARTICLE IN PRESS [mUS1Ga;August 12, 2020;17:6] B. Leiker and K. Wise / Disease-a-Month xxx (xxxx) xxx information within the ED group using group chat platforms. It seemed like nearly daily there were important new understandings of COVID and our team worked hard to share, interpret, and discuss this information. Our ED APP manager, Sue Bednar, APN, also held call-in meetings to field questions and concerns as well as sent out regular email updates. All these efforts were appreciated by staff because shared knowledge is important not only for personal safety but also for efficient and effective patient care. With our group trying to stay informed on ED workflows in several different ED pavilions, it was important that we received guidance and information from one central source. Sue Bednar, Dr. Wang, and all the other physician leaders in our group worked tirelessly to keep us safe and informed. Their work ensured that we felt calm and prepared for challenging shifts, that we understood PPE use and rationale and ED testing and treatment protocols, and that we had knowledge of current areas of stress in the system and measures to address these challenges and bottlenecks in daily workflow. All this reinforced the message that we were valued members of the organization. PPE use and availability As the first case of COVID was confirmed in the United States in January, hospitals, clinics, and essential businesses across America started to think about how they were going to protect their employees. There was scarcity of equipment like standard surgical masks, N95 masks, and gloves for not only essential businesses but the general public as many rushed to protect themselves and their loved ones. In addition, hospitals needed to ensure that they had sufficient gowns, face shields, shoe coverings, and hair coverings so healthcare workers could safely do their jobs, not just in the days but also the weeks and months to come. Having adequate PPE and training proved to be the most important means of enforcing workplace safety and preventing viral transmission to healthcare workers. Reports of high healthcare worker infection rates out of countries badly hit by COVID like China and Italy, worried healthcare workers in the US.75 Hospital employees everywhere were questioning if their employers had the resources to protect them as the number of COVID cases grew and if the PPE would be effective. Surrounding communities stepped up to help by donating any extra PPE they had. Despite shortages elsewhere, NorthShore has been fortunate to be able to provide adequate PPE for all employees that came in contact with COVID patients. Prior to the COVID pandemic, most employees hadn’t worn N95 masks often and most hadn’t been recently fit tested for proper N95 mask size. At each NorthShore hospital, fit testing was offered as hundreds of employees lined up to be refitted for appropriate sizing of N95 masks. As the months progressed, employees were retested for appropriate fit as the hospital ran out of certain sizes of N95 masks and alternatives were provided. In addition to the need for N95 mask fit testing, NorthShore had to also reeducate employees on proper use of PPE. On March 11th, NorthShore released their first statement regarding PPE use, drawing from WHO (World Health Organization) and CDC (Center for Disease Control) guidelines. NorthShore recommended full PPE when caring for confirmed COVID or PUIs in Immediate Care, ED, and hospitalized settings. NorthShore also had to address concerns of improper PPE donning and doffing procedures that could inadvertently expose staff: Kang et al.44 demonstrated that healthcare personnel contaminated themselves in almost 80 percent of videotaped PPE simulations. This was especially apparent during the Ebola virus outbreaks from 2014 to 2016.46 , 23 In early March 2020, there were concerns about PPE shortages that created a tension between appropriate use and unnecessary waste. CDC guidelines at the time did not recommend wearing masks when not around COVID patients, nor did they recommend masks for people without symptoms. It goes without saying that we all felt confused about PPE usage and what resulted were inconsistent practices within hospitals and also between hospitals. By mid-April every employee and visitor was required to be screened by taking temperatures and answering questions about symptoms or exposure prior to entering any NorthShore facility. With a negative screen, everyone entering the hospital was given a mask to wear throughout Please cite this article as: B. Leiker and K. Wise, COVID – 19 case study in emergency medicine preparedness and response: from personal protective equipment to delivery of care, Disease-a-Month, https://doi.org/10.1016/j.disamonth. 2020.101060 ARTICLE IN PRESS JID: YMDA B. Leiker and K. Wise / Disease-a-Month xxx (xxxx) xxx [mUS1Ga;August 12, 2020;17:6] 7 their visit. Distribution of masks was limited initially in efforts to preserve supply, but as the hospital recognized the difficulty of socially distancing at work to prevent spread of infection, universal masking became standard. As of early June, NorthShore’s positivity rate among employees is 13 percent, an improvement since enforcing universal masking and eye protection. It’s unclear how many of these positive employees contracted COVID at work or at home, but the decrease in positivity rate is a testament to the effectiveness of proper implementation of PPE. As NorthShore was able to increase COVID testing, PPE protocols became more regulated. Full PPE was required when interacting with patients with confirmed or suspected COVID including N95 mask, goggles or face shield, hair covering, plastic or cloth gown, and gloves. NorthShore and ED management worked hard to disseminate instructions on when and how to properly use PPE via handouts, emails, and videos. This was especially important for employees that needed to review how to use a PAPR and proper decontamination after performing an aerosolizing procedure like intubations (Fig. 2). Patients considered PUIs were flagged by the triage nurse and placed in a room with both contact and airborne precaution signs