Preventing the spread of monkeypox

 

To: Hospital leadership  From: HFEMSD The Colorado Department of Public Health and Environment wants to ensure protocols are in place in your hospital system to meet the requirements of the licensure rules as outlined in Chapter 4, General Hospitals, and support providers in collecting specimens and ordering monkeypox testing. According to Chapter 4 regulations for licensed hospitals, Part 11.1 Infection Prevention and Control Program requires the hospital shall have an infection prevention and control program responsible for the prevention, control, and investigation of infections and communicable diseases. On Aug. 3, 2022, Dr. Rachel K. Herlihy, MD, MPH, medical director and state epidemiologist for the Division of Disease Control and Public Health Response, sent the following message to hospital chief medical officers in response to the rising number of monkeypox cases in Colorado and to stress the importance of expanding access to testing for all Coloradans. With the addition of commercial laboratory testing options, there is sufficient capacity to test all specimens (including clinic, urgent care, and emergency departments). 1. Educate providers about testing and treatment.  CDPHE created resources for health care providers with links to information on appropriate PPE, how to recognize monkeypox, and how to collect specimens. It also contains information about how to counsel suspect monkeypox cases on home isolation. Additional resources are in development and will be shared as they are available. Treatment is available from CDPHE for eligible patients.  One strategy to consider is the identification of a monkeypox response champion in your facility or system.  This type of position has been successful in Colorado and other locations in serving as a point of contact for facility or health care system providers and as a liaison with public health and commercial laboratories. 2. Use commercial testing.  As of July 26, 2022, multiple commercial laboratories (including Labcorp, Mayo Clinic Laboratories, Quest Diagnostics, Aegis Sciences, and Sonic Healthcare USA) are offering monkeypox testing. The addition of these laboratories is expected to increase national testing capacity to 80,000 tests per week nationally and will allow the CDPHE Laboratory to focus resources on patients who are likely to test positive for monkeypox and who are unable to pay for lab testing.  Specimens for monkeypox testing should be sent to a commercial laboratory when covered by insurance so insurance payers can be billed for diagnostic testing. Health care facilities (health care providers, staff, and administrators) should establish procedures for ordering, collecting, and shipping specimens to commercial laboratories and ensure health care providers are referring specimens from patients with insurance to a commercial laboratory. Facilities should educate providers and staff on these procedures. Specimen collection guidelines provided by the individual commercial laboratories should be followed to prevent specimen rejection. Health care providers do not need to contact CDPHE prior to submitting specimens for testing at a commercial laboratory and do not need to contact CDPHE with results, as testing laboratories are required to report positive results and patient demographic information directly to public health per the state disease reporting regulations.  3. Use CDPHE testing for uninsured or underinsured patients who meet CDPHE criteria The State Lab does not bill insurance payers or patients for monkeypox testing and when approved, is an option for people who are underinsured or uninsured. Testing at the CDPHE Lab is indicated for the following people:  A person with a rash compatible with monkeypox who is uninsured or underinsured AND  Is a man who reports recent sexual or intimate contact with other men OR  Lives in a congregate setting such as a college dorm, detention facility, or jail, OR  Is experiencing homelessness OR  Has had skin-to-skin contact with someone diagnosed with monkeypox OR  Clinical suspicion is high and other diagnoses have been ruled out.  Health care providers seeking approval for monkeypox testing at the State Lab should call 303-692-2700 (303-370-9395 after hours) for approval OR submit specimens using LabOnline. Information on LabOnline is available here:  https://cdphe.colorado.gov/lab. Specimens being submitted to the CDPHE Lab without using LabOnline must be accompanied by a CDPHE laboratory requisition form. Facilities that need a requisition form or assistance setting up LabOnline access should contact cdphe_labcoordinators@state.co.us.  Health care providers, staff, and administrators submitting specimens using LabOnline DO NOT need to call CDPHE for approval and are able to access test results as soon as they become available.  People with an existing LabOnline account should use this form to request monkeypox testing be added to their account:  https://bit.ly/CustomerContactUpdates.   People who need to create a new account for LabOnline should fill out the form here:  https://bit.ly/LORegister.  Questions? Email  cdphe_labcoordinators@state.co.us