GW Nursing Simulation Reopening Plan

gwnursing

The George Washington University School of Nursing values a high quality educational experience. During this unprecedented time of the COVID-19 (Coronavirus outbreak), the creation of a safe learning environment for learners, faculty, and staff of the George Washington University School of Nursing Simulation and Innovation Learning Center is the first priority. The Simulation and Innovation Learning Center wants to provide high quality, high fidelity, nursing simulation and lab activities in an environment conducive to learning that maintains the standards of best practice for simulation and safety during the COVID-19 restrictions.

THE GEORGE WASHINGTON UNIVERSITY

SCHOOL OF NURSING

SIMULATION AND

INNOVATION

LEARNING CENTER

COVID-19

REOPENING

PLAN


TABLE OF CONTENTS

Introduction ..................................................... 3

1. Purpose ..................................................... 4

2. Scope ........................................................ 6

3. Definitions .................................................. 8

4. Procedures ................................................ 9

5. Process ....................................................12

6. Traffic Flow ...............................................13

7. Americans with Disabilities Act ....................18

Appendix ........................................................19

Appendix A: Cleaning and Disinfection

Guidelines…………………………………..19

References .................................................... 20

All information in this plan is subject to change based

upon changes in Center for Disease (CDC)

Guidelines and public health restrictions.

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COVID-19

Reopening Plan

INTRODUCTION

The George Washington University School of Nursing (GWU SON) values a high quality

educational experience. During this unprecedented time of the COVID-19 (Coronavirus

outbreak), the creation of a safe learning environment for learners, faculty, and staff of The

George Washington University School of Nursing Simulation and Innovation Learning Center is

the first priority. The Simulation and Innovation Learning Center wants to provide high quality,

high fidelity, nursing simulation and lab activities in an environment conducive to learning that

maintains the standards of best practice for simulation and safety during the COVID-19

restrictions. These Guidelines:

• follow The George Washington University Guidelines, The George Washington University

School of Nursing Guidelines and the Center for Disease Control and Prevention (CDC)

Considerations for Institutes of Higher Education (CDC, 2020b).

• follow applicable federal and state mandates to reduce the risk of exposure to the COVID-

19 Virus.

• provide recommendations for Personal Protective Equipment (PPE) use while in the

Simulation and Innovation Learning Center simulation, lab and OSCE spaces.

This Reopening Plan assumes that all undergraduates enrolled in the baccalaureate-nursing

program will return to the Virginia Science and Technology Campus (VSTC) starting August

31, 2020 (Fall 2020 Semester). This plan also assumes that there will be no graduate oncampus

events at VSTC for the Fall 2020 Semester. It is also assumed that there will be

on campus activities through Labor Day and Fall Break of the Fall 2020 Semester and all

on campus simulation and lab activities will terminate the week of November 22, 2020.

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1. PURPOSE

The Purpose of this plan is to establish standard guidelines for operations of the Simulation

and Innovation Learning (SAIL) Center to include the 301 OSCE suite, 307 Johnson Lab, 206

Student Practice lab, 205 Dawson Lab, 204 Health Assessment Lab, and 203 Paxton Lab.

These guidelines will govern the SAIL Center staff, faculty, learners, standardized patients, and

community members that utilize the space during the COVID-19 restrictions and during the reopening

process. These guidelines ensure the implementation of standards and guidelines

set forth by The George Washington University, GWU SON, CDC considerations for higher

education, Federal Occupational Safety and Health Administration (OSHA), and state, federal

and local government mandates to reduce and/or eliminate exposure to COVID-19 virus.

For the purposes of this document, definitions of phases for (whitehouse.gov, 2020) opening

are:

Safety

1. Phase I – Campus Closed to faculty, staff, learners, and community with the

exception of essential personnel.

2. Phase II – Campus is under restricted operations – teleworking when possible,

adherence to strict hand hygiene, maintain social distancing, limitations of group

sizes, and vulnerable populations should remain off campus

3. Phase III – Campus is under limited operations – vulnerable populations may return

with social distance, low risk populations limit time in crowded environments, limit

group sizes, and continue strict hand hygiene and environmental hygiene

4. Phase IV – Normal Operations with no restrictions

All food and drink are prohibited in the Lab and Simulation space.

Supplies for simulation activities provided by the simulation staff are single use or disinfected

prior to reuse.

During the COVID-19 restrictions, all personal belongings are to be kept out of the simulation

space unless it is a requirement of the activity (i.e., stethoscope, pencil, paper, etc.). All nonlab

related items will be stored outside of the lab area or in the provided cubbies utilizing

disinfection protocols. Belongings left at the end of the day will be discarded.

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Communication

Signage displayed at all entrances to the simulation/lab space indicates directional traffic

flow, requirements for entrance, and required personal protective equipment. Direct

questions, special requests, and concerns to the Director of Simulation and Experiential

Learning at cfarina@gwu.edu or via telephone at 571-553-0115.

The recommended reporting structure of the SAIL Center is to report non-emergent concerns

to faculty or staff, then the director of simulation, senior associate dean, and finally the dean

of the school of nursing. During an emergency, contact emergency services and report

directly to the director of simulation at the above referenced email or telephone.

Workforce

The workforce of the simulation center includes the Director of Simulation and Experiential

Learning, the Assistant Director of Simulation, Simulation Operations Specialists and

Simulation Information Technology Administrator.

Director of Simulation and

Experiential Learning

Assistant Director of

Simulation

Simulation Technology

Administrator

Crystel L. Farina, PhD(c), RN,

CNE, CHSE

Christine Seaton, DNP, RN,

CHSE

Paul Collins

cfarina@gwu.edu

571-553-0115

cdseaton@gwu.edu

571-553-8512

paulcollins@gwu.edu

571-553-0086

Simulation Ops. Spec. Cyndi Kelley cyndikelley@gwu.edu

571-553-0069

Simulation Ops. Spec Rebecca Melson rmelson@gwu.edu

571-553-0058

Simulation Ops. Spec Janice Ouellette jouellette@gwu.edu

571-553-0222

The workforce, the director, and assistant director of the SAIL center will supervise

learners, faculty and staff utilizing the simulation space to ensure adherence to the safety

guidelines put forth in this document to ensure the safety of all users.

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2. SCOPE

These GWU SON SAIL reopening guidelines apply to all staff, faculty, learners, standardized

patients, and community members (VIP learners, Renters, etc.) who will utilize the Simulation

and Innovation Learning Center. All staff, faculty, learners, standardized patients and

community members are required to read, understand and comply with these guidelines.

Class Size

During the Fall 2020 Semester class size will be limited by the space of the simulation/lab

spaces. Assigned workstations are provided to prevent spread of the virus and enhance

tracking. There is a limit of 25 workstations in the simulation/lab space to include 307 Johnson

(10 stations) 205 Dawson (10 work stations) and 203 Paxton (8 work stations). Lab sections

will need to be limited to 18-20 learners. Debriefing rooms in the Dawson area are limited

to 3 learners with an instructor and debriefing in the Paxton area is limited to 4 learners with

an instructor. Learners will not rotate between workstations. Workstations in the 307 Johnson,

205 Dawson, and 203 Paxton labs are approximately 100 sq. ft., exceeding the social

distancing recommendations of 36 sq. ft. recommended by the CDC (CDC, 2020b).

Health Assessment practice will take place in the OSCE center for the Fall 2020 semester.

Learners will be assigned OSCE care rooms in groups of two. Learners will maintain that

dyad during the semester to allow partnerships for procedures, monitoring, and tracking.

The OSCE space is limited to 24 learners in the 12 primary care rooms. Each OSCE room

is approximately 100 sq. ft., making it possible for two learners to be in each room and

ensuring the 36 sq. ft. recommendations by the CDC. In the health assessment course

learners will practice their assessment skills on each other. Learners will be required to

maintain appropriate and proper face covering, maintain hand hygiene, and adhere to strict

guidelines as noted in the Procedures section (page 9).

Groups and Gatherings

As noted previously, groups of learners may not gather in the debriefing spaces. They also

may not gather in the OSCE faculty space or the OSCE classroom as the space is not large

enough to socially distance the class. Instructions to groups larger than 10 learners will need

to be emailed in advance of the class.

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Scheduling

The simulation team, in collaboration with SON administrative team, will complete scheduling

of the lab and simulation space. The purpose of the scheduling as a team is to ensure

guidelines for social distancing and to prioritize the space for undergraduate and graduate

learners.

Scheduling of labs and simulation activities will limit numbers of learners based on space and

social distancing requirements. Learners will be assigned workstations in the lab and

simulation space to provide consistent tracking of student movement. Additionally, time will be

scheduled between simulation sessions to allow for resetting, cleaning, and disinfecting of the

SAIL Center spaces.

This plan is based on the current CDC guidelines (2020b) and the social distancing

requirements of 6 feet between people requiring a 36 sq. ft. area around each student. As

those requirements change the space allocations will be adjusted to meet the requirements.

Responsibilities

It is the responsibility of all faculty, learners, and staff to ensure a physically and

psychologically safe learning environment for all. There will be requirements specific to the

space and the equipment in use related to cleaning, disinfecting, and limitations.

All areas will be cleaned and disinfected between lab/simulation sessions. Learners, faculty,

and staff will be required to participate in the cleaning and disinfection needs as appropriate to

the assigned area. Please see Procedures for details. The simulation staff will be responsible

for ensuring that supplies and directions for cleaning are available in each area of the SAIL

Center areas.

All faculty, staff, and learners will be responsible for self-reporting temperature and symptoms

via Point and Click (PnC). See Procedures, Page 9.

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3. DEFINITIONS

This section of the plan provides definitions to ensure that there is a clear understanding of the

plan and the areas described in the plan.

Social Distancing – “A set of actions taken to stop or slow the spread of a highly contagious

disease. The goal of social distancing is to limit face-to-face contact to decrease the spread of

illness among people in community settings.” The current recommendation from the CDC is to

distance 6 feet from others (2020).

PPE – Personal Protective Equipment (PPE) is special equipment to protect an individual from

contamination by bacterial and viral pathogens. The special equipment may include gowns

(impermeable to moisture), masks, gloves, coveralls, face shields, goggles and more

depending upon the level of potential contamination.

COVID-19 – “A novel coronavirus is a new coronavirus that has not been previously

identified. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the

coronaviruses that commonly circulate among humans and cause mild illness, like the

common cold. COVID-19 is caused by a coronavirus called SARS-CoV-2. Coronaviruses are

a large family of viruses that are common in people and many different species of animals,

including camels, cattle, cats, and bats. (CDC, 2020a)

High-touch areas – “High touch areas can include doorknobs, arms of reception area chairs,

elevator buttons, stair railings, restroom surfaces, coffee pot handles or dispensers, water

cooler handles, chair backs, and automatic payment machines. These are areas that multiple

humans come into contact with or touch in public spaces. (Lyall, 2020)

Simulation/Lab Space – The simulation/Lab space or Simulation and Innovation Learning

Center (SAIL) includes the 3 rd floor 301 OSCE suite, 307 Johnson Lab, 2 nd floor 206 Practice

Lab, 205 Dawson Lab, 204 Health Assessment Lab, and the 203 Paxton lab areas.

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4. PROCEDURES

The following are procedural plans for re-opening of the SAIL Center during the COVID-19

pandemic restrictions.

Preparation to enter the simulation/lab space– If there are any symptoms of illness, or

they have tested positive for the flu or COVID-19, individuals (faculty, staff, learners, and

standardized patients) are asked to remain at home and follow the guidelines of their

healthcare provider to reduce the risk of spread to others in the area. Prior to entering the

simulation/lab space maintain hand hygiene by washing hands with soap and water for 20

seconds or using an alcohol based hand sanitizer when hands are not visibly soiled.

At the entrance of the simulation/lab space, maintain a distance of 6 feet or greater and ensure

that face covering/mask is properly in place.

Screening – All individuals (faculty, staff, learners, and standardized patients) will complete

COVID-19 screening prior to entering the SAIL Center spaces. The screening process will

consist of Point and Click (PnC) symptom screening will self-disclose information. The

process will require completion of a questionnaire. All symptom answers to the questionnaire

must be negative to enter the simulation/lab space. Individuals with a cough or shortness of

breath will not be permitted to enter the space and will be provided an alternative assignment.

Individuals with at least TWO of the following symptoms: chills, muscle pain, sore throat,

vomiting, diarrhea, headache, and loss of smell/taste will be restricted from entering the

simulation space and provided with an alternative assignment. (Bryant, 2020).Upon entering

the simulation space, display the green PnC badge to enter. Maintain a distance of 6 feet or

greater to social distance and protect privacy of those still completing the screening process.

Learners that have identified themselves as providing care to a positive COVID-19 patient or

have been exposed to COVID-19 will be monitored for symptoms, but will be permitted to

participate in simulation and laboratory activities. Additional PPE may be required.

Cleaning and Disinfection – The Simulation and Innovation Learning Center has been

cleaned and disinfected by the simulation staff prior to reopening. This includes all

equipment in the acute care rooms, primary care rooms, exam rooms, simulators, beds, and

linens. All equipment and simulators have been disinfected using Super Sani-wipes, left

to air dry, and not touched after cleaning during the shutdown of the simulation lab/ spaces.

All linens have been washed at high temperatures, folded and reapplied to beds or placed

in storage.

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All simulators, equipment and beds will be cleaned again, prior to learners re-entering

the simulation/lab spaces.

Each work station will be provided with a sanitizing cleaner. Learners, faculty, and staff are to

ensure that each work station is cleaned with sanitizing cleaner to all areas that were touched

prior to leaving the work station.

Gloves/Masks - Learners, faculty, and staff are expected to wear gloves when appropriate at

the work station. If gloves would not be worn for something in the acute care setting, they

should not be worn at the work station. Gloves are to be worn when touching the simulator.

Face coverings/masks are expected to be worn in the simulation/lab spaces at all times. If a

learning opportunity requires a mask, it should be placed over the primary mask during the

procedure and then removed after the procedure. For example, when learning how to apply

PPE, every student should already have a mask/face covering to be in the building.

To apply the PPE, add an additional mask to the face covering for the lesson and remove

only the secondary mask when the assignment is completed.

It is the responsibility of all faculty, staff, and learners to hold each other accountable for

properly wearing their masks. If someone has let the mask drop below their nose, please

speak up and ask them to adjust the mask for a proper fit. All masks must cover the nose and

mouth to be effective. Once the mask is correctly in place, individuals should refrain from

touching it or adjusting it if possible. If an adjustment is needed, hand hygiene is

recommended after the adjustment.

Movement in the SAIL Center – The SAIL Center is following the healthy environments

guidelines for the simulation/lab space (CDC, 2020b). Individuals are asked to remain in their

assigned space. If there is a need to leave the workstation, individuals are asked to raise their

hand and let the instructor know so that they can ensure it is safe to move through the space.

For example, if there is a need to use the restroom, the instructor will ensure that individuals

will not cross paths with others to move to the restroom. To reduce traffic flow and exposure

not all learners will be able to take a restroom break at the same time.

Prior to leaving the workstation – Prior to leaving the workstation, ensure that all supplies

and equipment have been disposed of or returned to original working order. Dispose of

supplies properly – sharps in sharps containers, trash in the trashcans. Remove gloves that

were used during the learning session. Don clean gloves. Wipe down all areas that were

touched during the learning activity to include equipment, simulators, beds, etc. Dispose of

disinfecting wipes in large white “pickle jar” containers. Remove gloves and dispose of in the

trash. Wait until signaled to leave the simulation/lab space.

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Simulation Staff – After individuals have left the simulation/lab space, simulation staff will

check each work station for supplies, restocking needs, etc., and spray bedlinens, workstation,

etc., with a disinfecting spray.

Products - During the COVID-19 pandemic there has been a shortage of name brand

disinfection wipes, such as Clorox Clean-ups and Lysol wipes. The SAIL Center has made

every effort to use Super Sani-Wipes or equivalent to disinfect the simulation/lab workstations.

Other disinfectants may be used by following the recommended instructions on the packaging

to maintain the anti-bacterial/anti-infective effects of the product. The SAIL Center is

considered a laboratory space and therefore is under the guidelines of GW Safety which

requires the appropriate disposal of chemicals that are used as disinfectants. The SAIL

Center will abide by the regulations and guidelines of GW laboratory safety.

Home supplies – As changes occur with COVID-19, course work may revert to an online

format. If that is to happen, individuals will be sent supplies and equipment to their homes to

ensure the continuity of learning. If this happens, it will be the individual’s responsibility to

maintain the safety and security of supplies and equipment. The Food and Drug

Administration offers resources for the collection and disposal of sharps. Learners will be

required to sign a memorandum of understanding when taking possession of the kits. Details

will be provided to learners as needed to cover safe handling, proper disposal, and cleaning

instructions.

Health Assessment Course – The Health Assessment course is a unique course where

learners will practice what they learn on each other. To maintain the safety of all learners,

additional PPE will be required during the course to include a face shield, in addition to a face

covering.

The OSCE center will be used for the Health Assessment Course for the Fall 2020 semester.

The floor plan for this space provides a sink in every private room. All learners are expected to

perform hand hygiene with soap and water for 20 seconds as the preferred method of hand

cleaning. Additional care and requirements may be needed as healthcare policies change.

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5. PROCESS

The process for entering the SAIL Center is outlined as follows:

• Prior to entering simulation/lab space perform hand hygiene

• Follow the traffic flow pattern of the building and space.

• Ensure that mask is covering nose and mouth

• Proceed to assigned work station

• Faculty and staff will provide additional learning support and supplies as needed

After Learning Activity:

• Remove gloves if needed and apply clean gloves for disinfection process

• Dispose of supplies in the appropriate receptacle (sharps in red sharps container, trash

and gloves in trash can)

• Wipe all areas of the workstation to include IV pumps, bed, bed rails, mattress,

simulator, bed side dresser, over bed table, documentation devices, oxygen flow meter,

oxygen tubing, and all other areas touched during the learning activity

• Remove gloves

• Exit work station when signaled that it is safe

• Follow directional traffic flow as indicated (see Traffic Flow)

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6. TRAFFIC FLOW

To ensure safety of all individuals in the SAIL Center, traffic patterns have been established

to minimize exposure of by crossing traffic paths in the simulation/lab spaces. From the first

floor of Innovation hall, designated stairwells for up and down have been established as well

as limits to the occupancy of elevators to maintain social distancing and safety.

First Floor

Stairs to the right of security near the student lounge are designated as an up stairwell.

to the left of security are designated as a down stairwell.

Stairs

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Second Floor

Arrival onto the second floor from the UP stairwell, turn right to move down the hall. Entrance

to the Dawson simulation lab area (205) and the health assessment classroom (204) will be

through the glass doors off the second floor elevator (205/204 Suite) only.

Exit of the Dawson simulation lab area will be through the utility exit door near the up stairwell.

Exit from the health assessment classroom will be limited to the 203-suite door.

Entrance to the 203 Paxton simulation lab will be limited to the door at the end of the second

floor hallway near the down stairwell. Exit to the 203 Paxton lab will be through the 203 door

(same as health assessment exit).

Individuals will maintain social distancing while entering and exiting all simulation lab areas.

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Third Floor

Arrival onto the third floor will be through the up stairwell or elevators. The hallway will flow to

the left off the elevators. Entrance to the Johnson Lab (307) will be through the large wooden

double doors. Entrance to the OSCE area (301) will be through the large wooden door at the

end of the hallway. Entrance to the OSCE classrooms (308) will be through the main OSCE

entrance and then turn right to enter the OSCE lobby from inside the OSCE suite. Traffic

inside the OSCE suite will move in one direction toward the parking lot and around the outside

of the rooms.

Exit to the Johnson Lab (307) will be limited to the glass doors near the elevators. Exit to the

OSCE center area (301) will be through the Standardized patient exit. Exit to the OSCE

classrooms will be through the OSCE suite lobby. The standardized patient suite and the

debriefing room in the OSCE center will be closed during the COVID restrictions due to the

small size of the rooms and the inability to social distance in those areas.

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There is an area between the Johnson lab 307, the OSCE Center 301, and the up stairwell,

where there will potentially be two-way traffic. The plan is to stagger admission and dismissal

times to and from those areas to eliminate two-way traffic at those times.

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7. AMERICANS WITH DISABILITIES ACT

CONSIDERATIONS

“The University is making accommodations for high-risk individuals to teach and attend classes

and, where feasible, work remotely. As outlined by the D.C. Department of Health and the

CDC, these include but are not limited to individuals with chronic lung disease, moderate to

severe asthma, serious health conditions, immunocompromised conditions, severe obesity,

diabetes, chronic kidney disease, and liver disease and those who are over the age of 65.

GW is giving all students the option to attend virtually; we expect many international students

and at-risk students to do so. The university is also increasing our offerings of classes that are

fully on-line.” (GWU, 2020).

The Simulation and Innovation Learning Center will make every effort to support learners that

need to remain remote. Supplies for learners that need to remain remote are available

through the Director of Simulation and Experiential Learning. Faculty will provide instructions

for remote learning sessions.

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APPENDIX A: CLEANING AND

DISINFECTION GUIDELINES

“Cleaning is defined as wiping surfaces to remove dirt, grime, and germs from the focused

areas. However, germs can also be moved from one surface to another if the same cleaning

tool is used. Unlike cleaning, disinfecting uses chemicals to eliminate germs from focused

surfaces. Disinfection is defined as using chemicals, for example, EPA-registered

disinfectants, to kill germs on surfaces. This process does not necessarily clean dirty surfaces

or remove germs but kills germs on a surface after cleaning and can further lower the risk of

spreading infection.” (Bryant, 2020 pg. 4.)

All equipment and high-touch surfaces to include: task trainers, simulators, IV pumps,

laptops, mobile workstations, over bed tables, bedside dressers, counter tops, telephones,

Pyxis, bed rails, headboards, wheel chairs, bedside commodes, stretchers, door handles,

oxygen devices, and all touched surfaces will be cleaned with a disinfecting wipe prior to the

start of each class session. All simulators and task trainers will be cleaned with soap and

water on a weekly basis.

Linens will be sprayed between class sessions with a disinfecting spray and will be removed

for professional laundering on an as needed basis.

GWU environmental services will provide daily cleaning of floors, sinks, countertops and

doorknobs, light switches, and additional hard surfaces under their oversite.

During cleaning and disinfection, individuals should wear gloves, follow the manufacture's

recommendations for the disinfectant, dispose of gloves after cleaning, and wash hands with

soap and water for 20 seconds upon completion.

Individuals should refrain from shaking dirty laundry, sharing personal items, and using

disinfecting wipes on skin, and mixing cleaning agents. Never mix bleach with another

cleaning agent.

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References

Bryant, K., (May 11, 2020). Policy: Safety guideline for reopening of simulation for Columbia

University School of Nursing Helene Fuld Health Trust Simulation Center. Columbia School

of Nursing Helene Fuld Health Trust Simulation Center Policy Manual.

Centers for Disease Control (CDC), (2020a). Coronavirus (COVID-19).

https://www.cdc.gov/coronavirus/2019-ncov/index.html

Centers for Disease Control (CDC), (May 30, 2020b). Considerations for institutes of higher

Education. Centers for Disease Control and Prevention.

https://www.cdc.gov/coronavirus/2019-ncov/community/collegesuniversities/considerations.html

George Washington University (GWU) (June 15, 2020). The George Washington University

Plan for Fall 2020: Prepared for the District of Columbia Office of Planning and Department

of Health.

Lyall, A. (2020). The high-touch areas you should be cleaning more at home. The Block.

https://9now.nine.com.au/the-block/coronavirus-how-to-clean-high-touch-areas/ae4eeb29-

24a5-44a2-b529-313745d0ae16

United States Department of Labor (n.d.). COVID-19 – Standards.

https://www.osha.gov/SLTC/covid-19/standards.html

The White House (n.d.) Guidelines: Opening up America again. President Trump’s Guidelines

for opening up America again. https://www.whitehouse.gov/openingamerica/

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