VA Portland Health Care System
Important update from the Director
Greetings my fellow Veterans:
First, I want to thank each Veteran who has sought care during this crisis. You have been patient, cooperative with masking guidelines and been so willing to try new modes of care like video connect on smart phones.
I also want to give everyone an update on a recent cluster of COVID-19 positive cases we are seeing in the Portland VA Medical Center right now.
The bottom line is we are still serving our Veterans with world class healthcare in a safe environment. Our doors are not closed, and we continue to see Veterans face to face each day for critical issues and we continue to provide services to all seeking care using either telephone care or one of our many telehealth modalities.
We are currently experiencing a cluster of COVID -19 Positive case on our Portland Campus. As of May 13, 2020, we have a total of 31 cases associated with this cluster. The people who have tested positive for COVID-19 are all associated with the Portland campus. At this point, the cluster appears to be limited to two inpatient wards involving the following:
o 6 patients
o 24 VA staff
o 1 medical trainee
Under the guidance of our experienced Infection Prevention & Control team and our community healthcare partners, we are doing everything we can to understand this situation and to work proactively through it using universal epidemic management principles to ensure the safety of our Veterans and employees. We continue to follow the guidelines established by the Centers for Disease Control and The Department of Veterans Affairs and we work in close partnership with our local health authorities and The Oregon Health & Science University.
The overall impact to VAPORHCS’s ability to provide patient care is minimal; however, as a precaution, we are not currently accepting ambulances to the emergency department or accepting inpatient transfers from outside facilities until the situation is well understood. Our Emergency Room is open for Veterans who need emergent care, we are just deferring ambulances. In addition, options to increase outpatient procedures will be placed on hold until the situation is resolved, and we can ensure the safety of all our patients, visitors, and staff.
We are continuing limited outpatient care and continue many virtual care options for all our Veterans.
On April 29, 2020, a Veteran was transferred from a community hospital to VAPORHCS for non-COVID-related care. Prior to admission, the Veteran was non-symptomatic for COVID-19 and tested negative. The Veteran was retested on arrival and on May 1, 2020, the Veteran’s COVID-19 test result came back positive. The Veteran was immediately place on enhanced precautions and transferred to the hospital COVID-19 unit. All contacts (both staff and other Veterans) were traced and tested accordingly; all identified exposed employees were considered low or moderate risk based on universal masking practices.
On May 4, 2020, a second inpatient Veteran who previously tested negative for COVID-19 with no concerning symptoms, was retested for a procedure and returned with a positive result. On that same day, VAPORHCS was notified that an employee had fallen ill and was being admitted to a community hospital with confirmed COVID-19. This employee had worked in the area of one of the patients during the previous week. The employee is currently home recovering.
What we are doing now on the involved units:
o Most staff and other personnel who are known to have had contact with the involved patients have been tested. We are working to re-test certain staff as appropriate and test others identified thru the contact tracing process. Over 500 tests have been run on Veterans and employees and we continue to test at regular intervals.
o A thorough review was conducted of safety precautions and operational procedures related to the use of personal protection equipment (PPE), patient flow, staff rotations, & patient care. As a result, we immediately;
- expanded requirements for using masks, eye protection, and hospital provided scrubs;
- re-emphasized of social distancing protocols;
- started regular temperature checks of staff in certain patient-care work areas.
o Impacted areas are being deep cleaned and treated with UV irradiation equipment.
Other actions taken or continued:
o All Veterans, visitors and staff entering VA Portland facilities will continue to be required to wear a cloth face covering or a procedure mask during all times while in any area of the hospital or CBOCs.
- Our clinical leadership team met with both the Oregon Health Authority (OHA) and the Centers for Disease Control (CDC) on May 8th a consultation on managing this cluster. They recommended much of what were have been doing including focusing on hand hygiene and social distancing, wearing eye protection for all healthcare workers and they supported our proposed approach to implementing enhanced precautions N95/eye protection/ gown /gloves for all patient care for the next week until the situation is better controlled in impacted areas.
They also endorsed our aggressive approach of concentric, widespread testing focusing first on directly impacted staff and circling out with re-testing asymptomatic high-risk staff and Veteran inpatients every 3-5 days within the 14-day incubation period.
What Now: A chain is only as strong as its weakest link, so we need to strengthen some of our practices that have already been implemented. We will test and monitor as we reassess the situation as we learn and move forward.
Relatively speaking, we have had limited cases of positive COVID-19 Veterans in our health care system but, sadly, we have lost three Veterans.
Total patient COVID-19 positive status at VAPORHCS to-date (as of 13 May 2020):
|Total||ICU(PVAMC)||Medical/\Surgical Impatient units
|Mental Health Unit
|Residential Rehab Treatment Program(Vancouver)||Out-Patient(non-VA location)|
We continue to monitor, test and retest identified staff and Veterans who were involved in this event. We have an adequate number of COVID tests and supply of needed PPE to provide care safely. This was an eye opener as we were, and continue to, learn about this virus and how it is transmitted.
I commit to you, our Veterans, complete transparency and an assurance that we will provide care in the safest manner possible.
Thank you for your service to our nation and for letting us serve you. We are in this together and together we will ensure the health and safety of our Veterans, our staff and our community.
Director, VA Portland Health Care System