UNC Health Guidelines Related to COVID-19

All personnel involved in clinical research activities involving direct participant contact must remain aware of and in compliance with the UNC Health guidelines for working in the context of COVID-19. This includes mask use and visitor policies.

Study team members with access to UNC Health domain sites may access information directly at: https://unchcs.intranet.unchealthcare.org/Pages/2020/novel-coronavirus.aspx.

UNC Health: COVID-19 Summary for SOM
(specifically for those without UNC Health Intranet Access)

A summary of the UNC Health guidelines for working in the context of COVID-19 will be maintained here and updated regularly for research team members who are not able to access the information directly on the UNC Health Intranet.

Stay home if you are sick, if tested for COVID-19, or if in close contact (i.e., household contact) with anyone tested for COVID-19; also notify Occupational/Employee Health!

With community spread of COVID-19 now occurring in North Carolina, we must practice social distancing (by avoiding crowds and staying 6 feet away from others) whenever possible at work and at home. We must also hold each other accountable. Wash your hands frequently and properly. And do not come to work if you are sick! More specifically:

• If you have a fever greater or equal to 100.0 F or a new or worsening cough or shortness of breath, do not go to work! If at work, go home and call Occupational/Employee Health at 919-966-9119. Employees should not call HealthLink. If it is a medical emergency, go to the Emergency Room or call 911.
• If you are tested for COVID-19, or have close contact (ex. live in a household with someone who is COVID-19 positive or who has been tested for COVID-19), you must not go to work and should call the Occupational/Employee Health at 919-966-9119.
• If an employee has a low, medium or high-risk exposure to COVID-19 at work, Occupational/Employee Health will be in contact with further instructions.
• If an employee returns from international travel or a cruise, they must call Occupational/Employee Health at 919-966-9119 prior to returning to work.

Daily Employee Pre-shift Wellness Checks (last updated August 6, 2020)

In an effort to protect the safety and well-being of employees, providers, participants, and the community at large; all employees/providers will be subject to a wellness check prior to the start of every shift. Those individuals found to be positive for symptoms consistent with COVID-19 will either not report to or will immediately leave the work environment (not enter the facility) and be advised to contact Occupational Health at 919-966-9119.

1. Employees whose work is solely performed in a university managed building (e.g. labs) – the wellness check must be performed by another responsible party (e.g. supervisor) or by self-reporting via an online system prior to reporting to work.
2. Employees who perform work in any UNC Health facility – all research personnel entering any UNC Health facility will be subject to daily wellness checks prior to entering. Effective Monday, Aug. 3, all co-workers are required to complete an online daily health self-assessment that will be easily accessible via your smartphone before reporting for your scheduled shift. These online assessments will replace the in-person wellness checks that have been in place for the past few months. In addition to the online daily health self-assessment, some areas (i.e. inpatient nursing units) may continue to use the colored dot system, which changes daily, and will be placed on everyone’s shirt/badge to outwardly demonstrate they have been screened. Please bookmark the link below that is most appropriate for you:
   • UNC Medical Center
   • UNC Faculty Physicians/School of Medicine

   Learn more about the tool and find FAQs here and listed below. As always, if you are experiencing any symptoms, please do not report to work and instead call the Occupational Health services that corresponds to your employer.

   • Q: What is changing about the daily wellness checks with dots?  The e-Wellness self-check screening  is designed to replace our existing process of daily wellness checks using dots with a more efficient process.  It is important to maintain wellness checks for all co-workers for infection prevention purposes. The expectation is for each employee to show their manager or supervisor the “thumbs up” page on a daily basis upon arrival to work. This can be completed by pulling up the “thumbs up” screen in front of the supervisor or by taking a screenshot, which will include the date and time of completion on the display.
   • Q: How often do I need to complete this survey?  Every employee should complete the online screening process every day before reporting to work.
   • Q: How does my supervisor/manager know I completed the wellness check?  The expectation is for each employee to show their manager or supervisor the “thumbs” up” page on a daily basis. This can be completed by pulling up the screen in front of the supervisor or by taking a screenshot.
   • Q: Will management get notified if an employee fails an online wellness screening?  No. If an employee fails an online wellness check, the employee will be  prompted to stay home and not report for their shift, to immediately call Occupational Health, AND notify their manager/supervisor.
   • Q: What if an employee does not have a smartphone or mobile device?  If an employee does not have access to a mobile device, they may complete the assessment on a computer in their work unit at the start of their shift.
   • Q: Why do I need to select UNC Med Center or UNC Faculty Physicians?  Which link should staff working in UNCFP clinics select?  UNC Medical Center employees and UNC Faculty Physicians/School of Medicine employees are served by separate Occupational Health Departments. The UNC Medical Center link directs employees to UNC Hospitals Occupational Health Services and the UNC Faculty Physicians link directs employees to UNC School of Medicine Occupational Health. The expectation is that employees should complete the assessment that links to their source of Occupational Health services.
   • Q: Where can I find my employee ID? Can I use my U-number?  If you do not know your employee ID, your U-number, ONYEN or system log-in is acceptable.
   • Q: Is there a way to automate the “thumbs up” page being sent on to managers and supervisors?  No, not currently. This functionality may be added in the future.
   • Q: For the wellness check, will staff need to take their temperature? Staff will only need to take their temperature if they feel like they may have a fever. If an employee answers “YES” to the question, “Do you feel like you may have a temperature of greater than 100.0F?”, then the employee should take their temperature and document it in the online assessment tool.
3. Employees who will be conducting visits in non-clinical spaces (e.g. Mary Ellen Jones) – the wellness check must be performed by another responsible party (e.g. supervisor or PI) prior to initiating a study visit.

The employee wellness check should include the following questions (subject to change or be expanded as needed based on current CDC guidelines):

• Do you have new muscle aches not related to another medical condition or another specific activity (e.g. due to physical exercise)?
• Do you feel like you may have a temperature of greater than 100.0°F?
• Do you have sore throat not related to another medical condition (e.g. allergies)?
• Do you have a new or worsening cough that is not related to another medical condition?
• Do you have shortness of breath that is not attributable to another medical condition?
• Do you have recent (<5 days) loss of smell and taste?
• Do you have new onset of vomiting or diarrhea not related to another medical condition?
• Do you have repeated shaking chills not related to another medical condition?

Participant Visit Screenings

Prior to a face-to-face visit, research personnel must perform participant telephone wellness screenings and confirm the appointment no more than 24 hours prior to the scheduled visit. For study visits occurring in non-clinical spaces or for those studies that do not utilize Epic, the participant wellness screening should be appropriately documented in the study records. Research personnel that have Epic access must document the completed screening in Epic using this tip sheet for any research visit that occurs at a UNC Health facility.

For patient and companion screenings in clinics not located at the UNC Medical Center, refer to the workflow document “UNC Medical Center Outpatient Clinic Screening” for additional guidance.

The below screening questions should be asked for all participants and companions. Any participant who screens positive should be referred to the UNC Health COVID-19 HelpLine at 1-888-850-2684 for additional screening and further instructions:

• Do you feel feverish or do you have a fever?
• Do you have a new or worsening cough?
• Do you have a new or worsening sore throat?
• Are you newly short of breath?
• Have you had a loss of taste or smell in the last 5 days?
• Do you have new onset vomiting or diarrhea?
• Do you have new onset of repeated shaking with chills not related to another medical condition?

Participants and companions will be re-screened upon arrival to a UNC Health facility by Front Desk staff. Research personnel must re-screen participants and companions upon arrival for visits that will occur in non-clinical spaces before the visit begins (e.g. no symptoms, no fever) and appropriately document the re-screening in the study records. Any participant who fails re-screening should be immediately masked and isolated in a private room, and clinical study personnel (e.g. PI) should be contacted and follow recommendations from Infection Prevention regarding referral for testing. Companions who fail re-screening should be immediately asked to leave the facility and to contact their primary care provider or other appropriate medical facility for further evaluation and testing.

Employee Mask Policy (last updated June 3, 2020)

UNC Health’s Individual Extended Use Mask Policy describes appropriate use of face masks by all UNC Health Care System (UNC Health) employees during the COVID-19 pandemic, by means of an extended use protocol designed to conserve masks while providing protection to all employees. All covered employees (including SOM) are expected to comply with this policy, and this policy prevails over any individual entity or departmental policies, as well as guidance from external organizations when the visit occurs at a UNC Health facility.

As part of our continuing efforts to keep our patients and co-workers safe, starting on Wednesday, June 3, UNC Health is updating the Extended Use Mask Guidance so that a new mask will provided each day (instead of after the current two shifts) for all staff and providers working at Caldwell UNC Health Care, Chatham Hospital, Johnston Health, Nash UNC Health Care, UNC Lenoir Health Care, UNC Medical Center, UNC REX Healthcare, UNC Physicians Network, UNC Rockingham Health Care, and Wayne UNC Health Care. The School of Medicine will follow the University’s policy.

• All UNC Health and SOM employees working on-site are required to wear a mask while at work, regardless of location, role or ability to engage in social distancing.
• Masks will be issued by the employee’s supervisor, with instructions for appropriate donning of the mask, and it is critical that employees perform hand hygiene prior to the handling of the mask. The supervisor will additionally issue the employee a brown paper bag for storage of the mask, labeled with the employee’s name and the date of issuance of the mask and used for storage during any breaks.
• Masks are to be worn continuously during the shift of work, except when leaving the work areas to use the restroom or taking breaks to eat or drink. During any break time when the mask has been removed, the employee is to follow social distancing guidelines, and is to maintain a distance of 6 feet from others. Masks should not leave the unit and should be stored in the paper bag provided.
• During any period when the mask is removed to allow eating, drinking or use of the restroom, it should be stored. When a mask is stored, it should be carefully folded so that the outer surface (patient-facing, potentially contaminated side) is held inward and against itself to reduce contact with the outer surface during storage. The mask is then placed into the paper bag issued to the employee for the purpose of storage. Masks are not to be left out of the storage bag when not in use.
• Masks in good condition will be stored at the work site as directed by the supervisor. Masks will be stored folded, as noted above, and in the issued paper bag with the employee’s name, and the date of issuance of the mask, written on the bag.  These masks will be used for one work shift (UNC Health only) and then worn as you leave work until you exit UNC Health property. It can then be worn into work for your next shift unless you reach your duty station (where you will receive a new mask). Then the prior day’s mask must be removed and discarded. SOM will provide 2 masks per week for each research worker (employee or student) who is working on the UNC campus. These storage requirements may be modified to suit specific work areas for shared services locations and other non-clinical sites with the approval of the area Vice President.
• Masks will be discarded if soiled, damaged, or become hard to breathe through. The employee should report this occurrence to his/her supervisor, who will access the clean mask supply of the unit to provide the employee with a new mask. If a new mask is issued, a new brown paper bag for storage of that mask should also be issued, and labeled with the employee’s name and the data of issuance.
• During mask use, no home-made or additional masks may be worn; only the issued mask should be used, as using additional masks could lead to contamination from additional handling and limit breathability through the mask. Cloth or homemade masks can be worn to and from the unit, since the issued mask is not meant to leave the unit, nor is it meant for use at home or other locations.
• Employees who work in 2 or more locations which are in different buildings should have a mask at each location, with storage for each. Masks should not be transported from one location to another.
• Exception to the continuous use aspects of this policy will be made for employees who work alone in a room with a closable door. In this situation, the employee must still wear his/her mask on leaving their office to go elsewhere, but may, when in their office with the door closed, work without a mask. This exception does not apply to offices in which multiple persons are working, nor does it apply to cubicles, or cubicle offices where to space above the cubicle is open to the more general office.

Detailed Instructions for Individual Extended Use Masks (last updated on June 2, 2020)

When using masks, these detailed instructions must be followed to maintain safety for yourself and others while conserving the supply of masks. These instructions are based on CDC guidance for extended use of masks and the best available scientific evidence and may change based on mask availability. View UNC Health’s video on “How to Wear a Mask” and use the printable guidelines poster on extended use of face masks for employees to reference while in work areas. Highlights of the detailed instructions are listed below:

How do I keep my individual extended use mask clean for extended use?

• You must take care to minimize touching your procedure mask. If you need to touch or adjust your procedure mask you should immediately perform hand hygiene.
• Wearing makeup that will come in contact with masks is strongly discouraged because it will lead to soiling of the mask and limit the extended use of the mask.
• It is not recommended that you add a secondary mask over your individual extended use mask as it could lead to contamination from additional handling and limit breathability.

How should I remove my individual extended use mask?

• If you are in a patient care area, you should leave that patient care area if you need to remove the procedure mask.
• Clean hands with soap and water or an alcohol-based hand sanitizer before and after touching or adjusting the mask.
• Remove the mask either by releasing the ear loops simultaneously or by untying the neck tie followed by the upper tie and pulling away from your face and body. Do not remove by grasping the front of the mask.
• Procedure masks should be carefully folded so that the outer surface (patient-facing, potentially contaminated side) is held inward and against itself to reduce contact with the outer surface during storage.

How should I store my individual extended use mask for re-use?

• The folded mask should be stored between uses in a clean paper bag, clean envelope or plastic bag that is not sealed. Allow the top of the bag/envelope to remain slightly open to allow in air.
• Storage bags should be disposed of and replaced at the end of every shift while working in any UNC Health facility. For employees working in SOM buildings, 2 masks per week will be provided for each research worker (employee or student) who is working on the UNC campus.
• Write your name and the date issued on your bag.
• Write your name on the edge of the mask itself (taking care not to damage the front).
• Do not store your bags in your locker, but in a designated container provided by your unit.
• Keep bags organized to prevent masks from falling out and becoming contaminated.

Employee Eye Protection

UNC Health’s Universal Pandemic Precautions is a safe, sustainable practice that protects you from exposure to unknown COVID+ cases. Universal Pandemic Precautions includes:

• Everyone wears an earloop mask when able (patient, visitors, vendors, and all UNC Health staff and providers)
• When a participant is not able to mask, staff must wear eye protection in addition to their own mask.
• Eye protection includes either a face shield, a face mask with attached face shield, or safety goggles or glasses that offer wrap around protection to the side of the eyes.
• Eye protection does not include standard prescription glasses (even with side shields) or contact lenses.
• Eye protection should be disinfected and reused after each shift or when used in an isolation room:
  • Wipe eye protection with an EPA registered hospital disinfectant and let dry
  • Rinse with water or alcohol if residue remains
  • Store in a bag with name and keep in a secure location
  • Replace if broken or no longer able to be cleaned

Special Airborne/Contact Precautions will continue to apply to patients known to be infected with COVID-19 or symptomatic patients under investigation for COVID-19.

Visitor Restrictions (last updated September 17, 2020)

UNC Medical Center remains committed to patient-centered, safe care throughout all of our hospitals and health care facilities. As the COVID-19 situation has evolved, our policy continues to evolve as well. Please review the updated visitor guidelines below effective Sept. 21. As is our current policy, additional exceptions will be granted for end-of-life situations, minors, and patients requiring family support. All visitors will be subject to health screening before they enter the facilities and at any time, and MUST wear masks at all times.

Updated Inpatient Visitor Guidelines:

• Visiting hours will be extended from 9 a.m. – 9 p.m.
• Adult inpatients will be allowed 1 visitor during the day (9 a.m.- 9 p.m.) and 1 visitor at night (9 p.m. – 9 a.m.).
• COVID patients will continue to have no visitors (except for laboring women, who may be allowed to have the birthing partner at bedside).
• Laboring mothers may designate two support people, which could include a doula. After birth, patients may designate one support person for the entire length of stay in the hospital. Visiting hours do not apply to these visitors.

Updated Pediatric Patient Visitor Guidelines:

• Two parents/guardians may stay with a patient in a pediatric area of the hospital or clinic. Parents/guardians cannot switch out visitation from 9pm to 9am unless there are emergent circumstances such as end- of-life, new traumas, or significant changes in patient acuity
• Pediatric COVID + patients are allowed one asymptomatic parent to stay in the room but if they leave they cannot return.
• Only one parent/guardian will be allowed in the surgical patient care area during pre-operative and post-operative care.

Updated Emergency Department Visitor Guidelines:

• Patients may designate one support person age 18 or older (unless patient is confirmed COVID-19+ or under investigation). Visiting hours do not apply to visitors in the Emergency Department.

Updated Outpatient Areas Visitor Guidelines:

• Outpatient and clinic areas will allow one companion per patient to be present, but we continue to encourage individuals who are able to come alone to do so in order to support social distancing efforts.
• In outpatient areas, all patients and visitors MUST wear masks for the entire visit.

Additional restrictions are as follows:

• No visitors under the age of 18 will be allowed to visit for the foreseeable future.
• Visitors who are over 65, pregnant or immunocompromised are discouraged from visiting.
• The number of entrances to the hospital will be limited. All visitors and patients, including vendors and contractors, will be screened at designated entry points, including the Emergency Department.
• All visitors must pass a health screening. No visitor with fever, cough, cold or flu-like symptoms may enter any UNC Health facility. These visitor restrictions may be revised as the COVID-19 situation evolves. No one should visit a patient if they have come into contact with someone who tested positive for COVID-19 in the last 14 days.
• An appropriate mask will be provided to visitors during the screening process.  Visitors will be required to be wear the mask at all times and will not be allowed to remain in the hospital or clinic without one.
• Patients under COVID-19 investigation may not have any visitors, unless compassionate care is approved.

Patient and Visitor Mask Policy

UNC Health’s Universal Mask Policy describes a universal face mask policy for all inpatients, outpatients, companions, and visitors to UNC Health facilities in response to the COVID-19 pandemic. The policy specifically addresses non-UNC Health employees visiting UNC Health facilities and prevails over any individual entity or departmental policies, as well as any guidance from external organizations as to mask use for the public. The patient and visitor mask policy also applies to participant visits that occur in non-clinical spaces.

Outpatient Clinics:

All patients, companions or visitors to any UNC Health clinic facility are subject to the following:

1. Patients successfully completing COVID-19 screening and admitted to the building will be given a clean, single use procedure mask and instructed to wear the mask at all times while in the facility. In order to conserve supplies, companions or other visitors will be provided a UNC Health mask only if they have no mask or face covering; for companions, home-made or cloth masks are acceptable. Only one mask per person is permitted.
2. Whenever possible, “Respiratory Etiquette Stations,” may be established at or just inside the entry of every facility entrance (including alcohol hand sanitizer, procedure masks and staff to instruct in the placement, wear and use of facemasks).
3. For the duration of the outpatient visit, both the patient and any companion(s) must wear their masks. Patients may discard the mask upon leaving the facility or take them home.
4. Vendors and others entering a UNC Health facility are required to follow the same protocol and wear a mask at all times while on the premises. In order to conserve supplies, vendors and others will be provided a UNC Health mask only if they have no mask or face covering; for vendors, home-made or cloth masks are acceptable. Only one mask per person is permitted.

Hospital Inpatients:

1. All inpatients, regardless of COVID-19 status, who leave their rooms for any reason are required to wear a procedure mask unless there is a medical reason making mask use infeasible.
2. Patients who are COVID-19 infected or persons under investigation (PUI) must also wear a procedural mask while in their room to minimize droplet dispersion.
3. Extended use protocols will be followed, and a single mask will be provided for a stay of four days or less, absent special circumstances. Inpatients will be asked to store their procedure mask in a clean brown paper bag or envelope, supplied by the hospital.
4. All inpatients, regardless of COVID-19 status, excluding anyone listed above should wear a mask when anyone enters their room.

UNC Health Travel Policy (last updated on June 5, 2020)

The COVID-19 Travel Policy implemented in March was reviewed and redefined based on the evolving phases of the current situation. The new policy now includes return to work requirements after travel and potential/known exposure to COVID-19. COVID-19 continues to spread across the US and North Carolina. In response, UNC Health is restricting employee travel for UNC Health business. Most importantly, this policy aims to reduce the spread of the virus and reduce the number of patients and colleagues who become infected. Slowing the spread of the disease is our best tool to save lives. Updated requirements were developed based on recommendations and what works best for our organization.

The updated policy and requirements are described below and can also be found on the UNC Health Intranet here. If returning from traveling, please consult with your local Occupational/Employee Health office.

Travel Type:

• Business International Travel Outside the state of North Carolina – all International travel for UNC Health business purposes is prohibited.
• Business Travel within the state of North Carolina (UNC Health Entities) or; Personal Domestic/International Travel or; Attending/participating in mass gatherings:
  • Consult the CDC COVID-19 Guidelines for Travel before considering travel. This includes wearing masks while in public.  Practicing social distancing is crucial when out in any community. Travel to areas of high rates of community COVID transmission is discouraged.
  • Attending mass gatherings of any kind is discouraged. Exceptions may be made if a gathering has a known outbreak (i.e. a conference experiences an outbreak); therefore, co-workers who attended may need to be out of work for 14 days after their exposure.
  • Co-workers are allowed to return to work after travel or group gatherings if asymptomatic and have practiced the CDC COVID-19 Guidelines for Travel.
  • Co-workers must adhere to the Extended Use Mask Guidance and continuous self-monitoring with daily wellness checks.
  • If you become symptomatic (cough, fever >0^o F, shortness of breath, loss of taste or smell, GI symptoms, sore throat, shaking chills), DO NOT come to work and call your supervisor and Employee/ Occupational Health

Visitor & Staff Entrance Changes for UNC Medical Center (last updated June 22, 2020)

Effective June 22, visitors will be screened at three public points of entry:

• Emergency Department (for emergencies only)
• Cancer Hospital (near Starbucks)
• Neurosciences Hospital entrances

Staff are encouraged to enter the building using Cancer Manning Level, Cancer Hospital near Pharmacy, or any of the staff doors at the back of the hospital (ex: Blood Bank entrance or DOC entrance).  Staff may use any doors to exit.

Especially during shift changes, we are seeing some visitors attempt to ‘piggyback’ and enter the building as our staff members enter/exit, which allows people to enter the facility without being screened. Thank you for remaining vigilant and helping to ensure that all visitors and patients, including vendors and contractors, are screened at the Cancer Hospital, Neurosciences Hospital, and Emergency Department entrances.

Additional COVID-19 Workplace Signage

COVID-19 Preventative Actions Poster

Physical Distancing in the Workplace – 11×17 Poster

Social Distancing Even in Elevators_11x17 Poster