Ensuring the Health and Safety of Our Patients

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Tri-County Health Care has always had a strong commitment to the health care needs of our communities. During this global COVID-19 pandemic, we know the health of our patients is essential, and their safety is our priority. We strive to provide our patients a safe, reliable place to receive care and have implemented measures to achieve that goal.patient safety measures include staff wearing PPE for all encounters

The last few months have seen many changes inside and outside of the doors at Tri-County Health Care. Our medical and infection prevention and quality control experts, with guidance from the Minnesota Department of Health and Centers for Disease Control, have created guidelines to ensure our facilities remain safe for patients to confidently receive care.

In-Person Appointments and Procedures

For many of our patients, maintaining good health means taking care of issues and having regular visits with their provider. Each patient’s circumstances are evaluated to determine if in-person care is required, or if they can utilize Video Visits or our eClinic.

We want to stress the importance of not delaying emergency care and to call 911 or go to the nearest Emergency Department for any of these or other urgent conditions: chest pain, compound fracture, difficulty breathing, heart attack, head injuries, major trauma, seizures, severe abdominal pain, severe burns, shock, stroke or uncontrollable breathing.

Visitor Restrictions

Our policy currently restricts visitors to reduce the number of people in our facilities. This helps to lower the risk of exposure between patients, visitors and staff. We understand this can be difficult for patients and family. However, it is a critical step to ensure the safety of all patients at Tri-County Health Care.

Screening

All patients, visitors and staff are screened for COVID-19 symptoms before entering the building. When patients arrive for an appointment, they are asked about any cough, fever or other symptoms of respiratory virus infection that they or anyone in their household may be experiencing. They will then have their temperature taken in the screening tent.

Masks and Hand Sanitizer

Patients, visitors and staff are all required to wear face masks at Tri-County Health Care. Patients may choose to bring their own or will be provided one at the entrance.

Nurse doing hand hygiene to prevent Coronavirus infection as part of patient safety measures.Hand sanitizer is available at all entrances and everyone is asked to sanitize their hands when entering the building. Our health care staff also sanitize their hands before and after seeing each patient.

Cleaning and Disinfection

The Environmental Services team makes sure to clean and disinfect high-touch surfaces and areas after patient contact. This includes cleaning waiting rooms every hour and all restrooms every two hours.

Additionally, nurses have always wiped high touch surfaces in exam rooms after each patient. They are now using a Coronavirus-killing disinfectant to make sure everything in the room is decontaminated before the next appointment.

A robot that uses ultraviolet (UV) light is also used to kill the Coronavirus, germs, and many viruses and bacteria in the Emergency Department, ReadyCare, operating rooms and hospital patient rooms. Read about it here.

Social Distancing

New processes have been put in place to reduce the number of people in waiting rooms and at registration to create a safe distance between everyone. Registration staff now have plexiglass barriers and waiting room seating is reduced to comply with social distancing.

We at Tri-County Health Care want our patients to have the confidence that they always receive safe, high-quality and compassionate care even during this time of crisis.


Coronavirus Mitigation: Cleaning and Disinfection

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The spread of the Coronavirus (COVID-19) has led to much uncertainty for people in their daily lives. Tri-County Health Care is committed to providing a safe environment for patients and communities, and remains open for business to provide health care during this pandemic.

The Environmental Services team ensures that cleaning and disinfecting is done every day to ensure patient safety.The entire staff has taken proactive measures to mitigate concerns around the Coronavirus. This includes new cleaning and disinfection routines throughout our facilities.

The TCHC Environmental Services team has worked with Quality and Infection Control, and monitored updates from the Centers for Disease Control and the Minnesota Department of Health to create guidelines for cleaning and disinfection of high-touch surfaces and areas directly after patient contact.

All waiting room areas are being cleaned and disinfected every hour and all restrooms every two hours. These areas were previously cleaned a couple times each day. If a patient has been in the area, the cleaning staff is not far behind to disinfect all surfaces that may have come into contact.

“We have always cleaned the same surfaces, but are now doing it more often,” said Betty Klingaman, TCHC housekeeping supervisor. “We are doing a very thorough cleaning, and disinfecting all high traffic surfaces every hour.”

The standard disinfectant proven to kill the Coronavirus is sprayed on a surface and left for 10 minutes of contact time before being wiped down. All high touch surfaces including chairs, counter tops, tables, door handles, light switches, handrails and many more, are repeatedly disinfected.

Nurses have always wiped high touch surfaces in exam rooms after each patient. They are now using a Coronavirus-killing disinfectant to make sure Ultraviolet cleaning machine used to disinfect and kill the Coronavirus. Housekeeping employee stands behind and pushes machine along.everything in the room is decontaminated before the next appointment.

Utilizing Ultraviolet Light to Kill the Coronavirus

One new and exciting device in use at Tri-County Health Care is a robot that uses ultraviolet (UV) light to disinfect surfaces and kill the Coronavirus, and many viruses and bacteria in patient and exam rooms. The robot is set up and items are moved away from the wall so the UV light can hit every part of the room for thorough disinfection.

This robot is used in all ReadyCare rooms every evening. It is also utilized in the Emergency Department, operating rooms and hospital patient rooms.

Staff members do their regular cleaning and disinfecting routines prior to running the UV robot. Utilizing the robot adds another important layer to the process for limiting the spread of not only the Coronavirus, but many other potential contaminants.

Each member of the Environmental Services team plays a crucial role in making sure it is safe for patients to come in for any healthcare need.

“Our department is very conscientious of all the work they do and make sure to cover every area,” Klingaman said. “I feel very confident we are doing what we need to do and that our patients are safe.”


Meal Planning Tips During The Pandemic

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What’s for supper?! It’s the question in the back of my mind all day. I want my family to eat healthy, but as a busy mom of three, I also need quick and easy. It’s getting even more difficult during the Coronavirus pandemic because we are trying to make less trips to the grocery store while also making sure all of the homework gets done at night. I know drive-thru or convenience foods would be quicker and much easier, but as a Registered Dietitian, I also know the importance of a good healthy meal! Here are a few of my grocery shopping tips and tricks to help plan healthy family friendly dinners during this pandemic.

Keep a Well-Stocked PantryHappy family talking while having dinner in dining room.

Take time to make a grocery list — go through your cupboards and pantry and try to keep a two-week supply on hand. Here are my MUST have pantry items that are nutritional and can be used in a variety of ways:

Shelf Stable Items

  • Canned beans — I rinse them off in a colander before adding to soups, casseroles, taco meat or even on top of a salad for more protein. Try black, garbanzo, kidney or white beans.
  • Canned vegetables with no added salt. Tomatoes can be added to soups, casseroles, spaghetti and sloppy joes.
  • Canned fruit in 100 percent juice or water. NEVER buy canned fruit in syrup because it is just added sugar.
  • Whole grains — Whole wheat pasta, brown rice, oatmeal, wild rice and whole wheat wraps are great options.
  • Peanut butter – Look for a natural option which can be identified by a brown lid.
  • Healthy oils to cook with or make homemade dressing. Olive, canola and vegetable are a few to consider.
  • Dried herbs and spices – These help in making tasty meals for the whole family!

Frozen Foods

Yep, the freezer is for more than just ice cream and frozen pizza!

  • Vegetables — With less trips to the grocery store, I stock up on frozen vegetables so we can always have one with dinner. The quality is great and there is a wide variety. Be sure to avoid the frozen vegetables that have sauce on them.
  • Fruit – There are many great options of frozen fruit to make smoothies or add to healthy yogurt for a parfait.
  • Lean meats – Stock up on chicken, seafood, pork loin or lean ground beef.A meal plan for a pandemic week on a white table among products for cooking - pastas, basil, vegetables, lime, seeds, nuts and spices.

Remember: Out of sight, out of mind! Don’t keep your pantry stocked with chips, candy, soda or other junk food. If it’s not there, you won’t eat it!

Plan Meals Based on the Foods You Already Have

  • To reduce your trips to the store, get creative with what you have on hand. Pinterest is a great tool for ideas.
  • For example, if you have leftover steak and vegetables, you could turn that into quesadillas using whole wheat tortillas or make an egg dish by chopping up the meat and vegetables and cooking it all together.

When You Have to Go to the Store

  • Create a detailed grocery list that is organized in the order you will walk through the store. This will not only save you time, but also reduce the risk of exposure to the Coronavirus.
  • Wear a face mask.
  • Disinfect your hands and cart when you get to the store.
  • Practice social distancing (6 feet) from other shoppers.
  • Practice safe shopping by making it a solo trip. Do not bring children or other family members with you. This also reduces exposure!
  • Remember to wash your hands BEFORE and AFTER putting your groceries away when you get home!

Can the Coronavirus live on fresh fruits and vegetables or food packaging?

  • According to the USDA, FDA and CDC there is currently no evidence to suggest that the Coronavirus can be transmitted through food or food packaging. However, it is possible for the virus to survive on surfaces and objects, so practice good hand hygiene and food safety.
  • Wash ALL fruits and vegetables before eating, even if they have a skin or peel that you will not eat (melon, bananas, cucumbers).
  • Produce with a firm skin should be washed with a produce brush.
  • Do not use soap, bleach, or other household products to clean your produce.

When I need inspiration for healthy recipes I go to:

Shelby Hunke family of five About the Author: Shelby Hunke is a Registered Dietitian working at Tri-County Health Care in the hospital and clinic. She has a degree in exercise science and a passion for helping patients live a healthy lifestyle. She lives in Wadena with her husband, Paul, and three kids, Madison, Jackson and Conor. In her spare time, she enjoys family time, running and the outdoors!


Social Distancing: Navigating the new normal

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When I was in Mrs. Basche’s 5th grade class, I had an obsession with two things: chewing gum and brushing my hair. Chewing gum wasn’t allowed in class or school but that wasn’t enough of a deterrent for me. I liked gum and spent my allowance on it, so it was mine to chew where and when I wanted. It was the early 80’s so hair was a big deal and working on becoming an even bigger deal! I had this cool Goody-brand brush that I absolutely loved which I purchased from Sterling Drug Store with my allowance (along with a jumbo Lip Smackers in Tootsie Roll flavor).

Mrs. Basche didn’t share my enthusiasm for chewing gum and brushing my hair. First of all, chewing gum was illegal (oh, the elementary school crimes!) and she didn’t allow it in her classroom. If she found that a student had gum, they were required to take it out of their mouth and put it on their nose for the rest of the school day.social distancing in the supermarket

The punishment was social shaming.

She took a different approach with my obsession for brushing my hair. She took me aside and said that I need to “calm down the brushing” and perhaps consider only brushing my hair before and after school — not during her class as my hair might fall out from all that brushing. This was more of a deterrent than anything else she could have mentioned!

Lately, I feel like, even though I am – ahem — so many years old, I have felt more and more like that 5th grade version of myself.  No, I am not obsessively brushing my hair and chewing gum while quarantined (it’s a call for help if that starts happening!), but I am not sure how to act or behave. I am not sure I completely understand the rules of the Coronavirus mitigation and I don’t want to be socially shamed.

Don’t get me wrong, I am following the rules and staying in quarantine and isolation whenever possible. However, I find myself in a few situations where I actually see other human beings that aren’t related to and live with me and that aren’t on Zoom or FaceTime.

I was at the grocery store the other day looking for some ingredients to make fajitas or street tacos (I will say that staying home has made me think outside the box on my food menu — there is only so many days of enthusiasm for goulash, spaghetti, tacos, and hot dogs. I thought the world was going to explode when I announced to my family (all men, mind you) that we were going to have a salad for supper. A salad, nothing more — just salad with a lot of fresh cut veggies. There was almost a full-out revolt. I conceded and asked: “would you like a type of protein with it?” My son replied: “you mean, like meat?”

Woman wearing face mask buying grocery in supermarket during Covid-19 pandemic. Female with a shopping cart purchasing some food items in supermarket.An older gentleman was looking at the same things I was in the grocery store, so I moved my cart and made sure to practice safe social distancing from him. He kept moving down the aisle toward me; I kept on moving away. I don’t know that he fully realized how close he was getting and I wasn’t sure he wasn’t trying to “socially distance bully me” away from the meat I was looking at. Was someone watching us? I stopped what I was doing and glanced around the store. Were they going to come up and get us into trouble?

This social distancing thing is hard to understand.

Another time, I was at the gas station filling up my car and went in to pay and get milk, only to realize that there was a line of people waiting to be checked out. I didn’t want to stand in line because it was a small space to begin with, but I didn’t know what to do with myself. I walked around and did a little shopping which is something I normally do not do at a gas station.

My mind wandered while browsing: How much is the bread here, do they have eggs, I would really like Corn Nuts but they are all carbs, the pizza smells good but I shouldn’t have that either. I was wasting time because I didn’t want to put myself in a situation of being “too close” to people. I didn’t want someone to tell me to “back off” or “social distance myself” or look at me like I didn’t understand how to use recommended forms of mitigation.

When I back my car out to go to work, I swear my neighbors are looking at me thinking – “there she goes again, where is she going? Shouldn’t she be at home?” I want to tape my letter from work that states I am in health care, so they all see that I have a legitimate need to travel during this Coronavirus pandemic. I am supposed to be doing this and I’m not breaking the rules!Social distancing being practiced at supermarket payment counter in Malaysia, with 1 meter gap between people in queue.

This whole thing has me re-thinking and questioning norms. I don’t know if the man at the grocery store was trying to “socially distance bully me” or the gas station customers thought I was too close. Do my neighbors really think these things when I get in my car and back out of the driveway?

I want to do the right thing and I want people to be safe. I want my family and myself to be safe.

In the same sense, I don’t want to be forced to put my gum on my nose like when I got caught in 5th grade. Mrs. Basche did catch me and told me to put my gum on my nose, but I refused to be socially shamed. So, I swallowed it, thinking the gum would now have a 7-year sentence in my stomach, and I took the after-school detention. I did take her advice though and “calm down my hair brushing” which as an adult I can see with 20/20 vision how annoying it was to her, as the teacher, and all of my classmates.

Right now, it’s like we are all back in school trying to figure out how to navigate a changing world where as we grow and learn, we adjust to the social norms around us.

After 9/11, we all learned that destruction and suffering could occur in a matter of minutes through the use of planes as bombs and ideology as inflictors of terror. We learned that security and privacy were not separate entities. It was as if we learned that there were new rules added to this game called the human existence.

The Coronavirus has led to rules changing, and us along with it, but this world classroom has a lot of students in it and we are learning — all of us, together — as uncomfortable as it might be.

About the Author: Susan Marco lives with her husband, Troy, and has two children, Kenzie (21) and Jack (18). Susan enjoys spending time with her family and enjoys reading and writing. Susan also has her own personal blog where she writes about her various experiences as well as tackles the topic of Alzheimer’s, which she knows first-hand in caring for her mother.


Video Visits offer safe option for health care

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As health care facilities prepare for a surge from the COVID-19 pandemic, patients seeking regular services are seeing changes to their appointments. Tri-County Health Care has worked to accommodate patients in the safest possible way. One important step toward increasing safe access to health care now comes in the form of Video Visits.

This new option opens the door for new or existing patients to receive virtual care for a variety of conditions by connecting them with a Tri-County Health Care provider right from the comfort, convenience and safety of the home. Video Visits eliminate the risk of spreading Video Visits Infographic Imageillness, save on travel time and expenses and allow patients to safely meet with their provider. It also helps conserve the use of masks, gowns and other essential personal protective equipment that are in high demand.

Providers will evaluate, diagnose and prescribe treatment from remote locations using technology such as a smartphone, tablet or computer. Patients and providers see, hear and speak to each other throughout the appointment.

“This virtual option offers the convenience of saving people time and gas money while also keeping everyone safe by minimizing exposure for both patients and staff,” said Julie Meyer, M.D. “It’s a great option and opportunity to stay connected to patients and be available to answer questions and reassure them during this time of crisis.”

Video Visits are similar to an in-person office visit and several of the same services are offered, including routine care appointments, diabetes check-ups, hospital and emergency department follow-ups, Behavioral Health and Mental Health visits, physical therapy and many more. Not all appointments can be completed through Video Visits. Services such as physical exams, lab orders or other in-clinic follow-up procedures may be excluded.

Patients will need a smartphone, tablet, or a camera-enabled laptop or desktop computer, microphone and access to high speed internet. The appointment is then completed through MyChart.

To find out if a Video Visit is appropriate for you, please call 218-631-3510. To learn more about Video Visits, click here.


Pandemic PPE: Intubation boxes provide new barrier

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There are community heroes busy donating their time and effort toward creating personal protective equipment (PPE) to help fight the spread of COVID-19 among health care workers. They are making face masks, gowns, face shields and anything else that can help. Gary Domier of Perham may not have picked up a needle and thread, but he did put his handyman skills to work by building three intubation boxes to protect the staff at Tri-County Health Care.

Creating a barrier to block the virusDoctor demonstrating how an intubation box is another form of PPE in the fight against COVID-19

There has been widespread coverage of the importance of ventilators to help treat the most severe COVID-19 patients. To use the ventilator, health care workers need to intubate the patient, which requires putting a breathing tube down the throat.

During this procedure, the virus is often aerosolized which puts everyone around the area at risk of infection. It is one of the highest risk procedures for treating COVID-19 and that is where the protection of the intubation box comes into play. The box fits over the patient and has a pair of holes where the health care worker can put their arms through to safely perform the intubation process. A clear piece of plastic is draped over the patient so if the virus is airborne in the process, it is concealed within the box.

“The intubation box is a barrier between health care workers and the patient so we’re protected from this aerosolizing virus being exposed to us,” said Rachel Redig, M.D., and Emergency Department Director, and Trauma and Stroke Director at Tri-County Health Care. “This will be used for anyone who is having respiratory distress where they can’t breathe or breathe well enough and needs the assistance of a ventilator. It gives us a very important extra level of protection.”

Building that extra level of protection

Dr. Redig, like many Emergency Room providers around the country, has been diligently researching ways to limit the spread of the virus in the health care facility. She has tapped into a network of ER providers who share tips and tricks on social media. The idea to create these intubation boxes came from a hospital in Chicago, IL.

There has been a rush to acquire PPE and purchasing pre-made intubation boxes was not an option. Fortunately, Dr. Redig knew someone who would be up to the challenge of creating them.

Gary, who is Dr. Redig’s father, usually spends his time woodworking but knew he could build these boxes. The two of them found plans for the boxes online, modified as needed, and Gary started his new project.

The walls are constructed of plexiglass and the frame is comprised of PVC. He spent a day learning the best way to put the boxes together. After the first one was completed, it was brought to TCHC where experts examined it and made notes of any adjustments that would maximize the effectiveness of the box.

Gary finished up the next two in a day, sealed them with caulk and they were ready for use.

“It seems like most of the equipment is being sent to the east and west coasts so we have a shortage up here,” Gary said. “In the end it’s a good feeling to be able to do something like this.”

“We have had several talks about health care workers being exposed day in and day out and the worries about our health,” Dr. Redig said. “I can’t imagine what that is like as a parent, but I think he was thrilled to be able to contribute and provide that extra protection.”

Intubation boxes put to use

There has not been a need for intubation boxes at TCHC in the past, but Dr. Redig has already received positive feedback about using them as an additional protective measure.

photo demonstrating the procedure of intubationThe boxes have been used a couple of times, although not with any COVID-19 patients, and have yielded good results and success.

The boxes Gary built have also had health care personnel outside of TCHC inquire about how to construct their own. After the boxes were built, Dr. Redig posted pictures of them on Facebook, and health care facilities from around the area reached out for the plans.

“These boxes are not a new device, but they haven’t been routinely used anywhere. But with COVID-19 coming, it’s a desperate need for procedures where we are exposed to getting the virus,” Dr. Redig said. “We are using it on all patients we have needed to intubate. It has been used with good success and our health care staff are thrilled to have another measure of protection.”

For updates and additional information about COVID-19 from the experts at Tri-County Health Care, click here. Tri-County Health Care also offers free COVID-19 screening online through its eClinic.

How to support TCHC in the fight against COVID-19

TCHC really appreciates all of the community support pouring in to provide our frontline staff with more PPE. Donations may be dropped off on the table located outside the front entrance of the Wadena Clinic. As we plan for the possible times ahead, we are specifically in need of manufactured N95 masks.

Additional needs include:

Cloth face masks
Clear plastic face shields
Safety goggles
Safety glasses
Used scrubs
Sealed bottles of hand sanitizer


Coronavirus: Experts Tackle Social Distancing and Mental Health

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The entire country has spent the better part of the last month practicing social distancing due to the Coronavirus. Minnesota Governor Tim Walz has extended the “Stay at Home” order through May 4. Early numbers indicate that these measures have helped to “Flatten the Curve.”

While it is encouraging to see data that reflects progress in the fight against the Coronavirus, it is still vitally important to continue with these mitigation measures. That means limiting exposure to anyone outside of the immediate household. It also means more time out of the comfort zone, which can have both a physical and mental effect. This week, our experts discussed the continued importance of social distancing in addition to providing tips to adjust to stressful and uncertain times.

 

Q: Am I allowed to visit friends and family?Professional doctors and nurses posing together in a hospital ward and wearing protective suits, coronavirus outbreak emergency concept

Ben Hess, M.D., stresses the importance of staying at home and practicing social distancing. This includes both in the health care setting and in the community.

Dr. Hess: First, Tri-County Health Care is restricting visitors to reduce the traffic throughout our buildings. Even though we do not have any COVID-19 positive patients at this time, we are still operating like it is present in our communities. Anyone coming into the building who doesn’t need to be there has the potential to walk away and spread the virus despite the protective measures we have in place. The virus can hide on all types of surfaces and you never know where you can pick it up.

As for visiting friends and family outside of a health care facility, I would strongly advise against it. Social distancing should be practiced with anyone who is not living in your current household. There are some exceptions, like having children in daycare, but just visiting family, friends or neighbors is a dangerous thing to do as it can spread the virus throughout the community. Even if you are not worried about your own health, you don’t know how many people you may inadvertently infect.

 

Q: How does Coronavirus compare to other contagious diseases from the past?

Tri-County Health Care has a provider on staff with firsthand experience battling a contagious disease. Alfredmy Chessor, M.D., treated patients in Africa during the Ebola epidemic in 2014-15. She explains another reason why it is vital to practice social distancing to combat the spread of the Coronavirus.

Dr. Chessor: With Ebola, it was very obvious when the patient was ill and deathly sick. This made it was easier to distance and protect yourself with the proper equipment. With Coronavirus, there are people who have the virus but show no symptoms. These are the ones spreading the virus without even knowing it. When we talk about social distancing and work toward flattening the curve, we are trying to minimize the risk of spreading the Coronavirus to people who are more susceptible. An individual may show no signs or symptoms, but even in a mild symptom state, they are highly contagious to those around them.

 

Q: What are some tips to manage mental health and make it through these stressful and uncertain times?

Aaron Larson, M.D., sees patients in Behavioral Health Services and knows it is a stressful time for many people. People are thrown out of rhythm and are isolated at home and not able to visit friends and family. It can be hard to cope and make necessary adjustments, but there are tips to maintain a positive mindset.

Dr. Larson: We are bombarded with information, suggestions, rules and different ways of doing things while also fearing for our health and the health of our families, friends and communities. Here are a few points to keep in mind when adjusting to this new abnormal.

Emotions

Emotions can range from fear, anger, denial, acting out or further isolation beyond social distancing. Be on guard against the overwhelming nature of these emotions. It’s okay to be frustrated, angry and scared, but don’t get stuck there. Not paying attention to these emotions and reactions can lead to maladaptive behaviors such as substance abuse, or self-medication to stay awake or to calm down.

Information

We see a constant stream of information from many sources – national, world or local. I suggest relying on local information. Read or listen Video call online during quarantine to keep social distanceto it once or twice a day, get what you need and let it go. The 24-hour news cycle is only going to increase anxiety and you can get caught up in a cycle that is constantly changing.

The local health care experts know what is going on. When the information is received, be acceptable to the change it may bring. It may seem negative at the time but don’t get hung up on it.

Self-Care

We are trying to adapt to a new normal and our brains are learning how to do this. It is important to stay connected to people. Call, video chat or connect with a friend through social media. It’s important to connect with elderly relatives and let them know you love them and care about them. They may be more isolated.

Make sure to take care of your physical health. Get outside and take care of yard work or finish that house project you have been waiting to complete. Remember to take your regular medications and have an adequate supply. Taking care of your physical health will leave you in the best condition to fight off the virus if you do get it. Remember to stay safe and don’t do anything that will require a trip to the emergency room. It may be overburdened due to the virus.

Q: What can I do if I want to see a provider for a minor illness but don’t want to risk being exposed to the Coronavirus by leaving the house?

A: Patients have the option to seek care online through the TCHC eClinic where providers can virtually diagnose, recommend treatment and prescribe medication. (Our eClinic also offers FREE Coronavirus screening)


Coronavirus: Ask the Tri-County Health Care Experts

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States around the country have been taking drastic measures to help limit the spread of the Coronavirus, also known as COVID-19. Governor Tim Walz has issued an executive “Stay at Home” order for Minnesotans to significantly mitigate person-to-person contact.

While many people in the state will be staying home to help “Flatten the Curve,” Tri-County Health Care staff remain busy preparing for the Coronavirus to reach our communities. We know there are many questions circling this pandemic and our experts at TCHC wanted to take the time to answer questions on a wide range of topics. This week, our experts cover who is considered in the high-risk category, how children are affected, ways to clean and disinfect your home and alternative options to seek medical care during this pandemic.

Coronavirus Q&A ask the experts imageQ: What groups of people are considered in the high-risk category?

The reason so many experts stress the importance of social distancing is because it is crucial in reducing the spread of the virus to high-risk individuals in our communities. Ben Hess, M.D., explains who we are working to protect while social distancing.

Dr. Hess: When we talk about high-risk patients, we’re talking about two specific groups – people who have an increased risk of catching the Coronavirus and another group who may struggle after becoming ill with it.

The first group includes people who have problems with their immune system. This can be people who have an autoimmune disease or are on medication that suppresses their immune system. These people not only have a higher risk of catching Coronavirus, but are also more likely to become seriously ill.

The other group includes people with chronic conditions like diabetes or heart disease. Even if they have good control of their condition, we still want them to take precautions like they are in the high-risk group. While they may not catch the Coronavirus quite as easily, their chronic diseases can play a much larger role if they do become ill. For example, if a patient has a condition like diabetes under control, but then becomes critically ill, their body can no longer control the diabetes and their complications worsen.

Q: How does the Coronavirus affect children?

Dr. Hess: Studies show young children tend to tolerate and do much better with Coronavirus symptoms than adults. They are in the low-risk category and have a low chance of getting seriously ill or hospitalized from the Coronavirus. The risk isn’t zero, but it’s much lower than adults.

Q: What are ways to clean and disinfect inside the home?

Many people are wondering how to best clean and disinfect areas in their own households. This is important not only to prevent the spread of the Coronavirus, but also good practice for everyday germs. The Environmental Services team does this on a daily basis at Tri-County Health Care and has tips for how to best keep the household clean and free of germs.

Betty Klingaman, TCHC Housekeeping Supervisor: Using a bucket and rag, make sure to clean and disinfect frequently touched surfaces. These contact surfaces can include handles, desks, phones and keyboards. Make sure to clean all parts of the contact surfaces, including underneath tabletops and desks. If the surface is dirty, clean with soap and water prior to disinfecting.

Homemade disinfectant:

-Mix 5 tablespoons or 1/3 cup of bleach per gallon of water, or 4 teaspoons per quart of room temperature water.

DO NOT use hot or cold water – this minimizes the effectiveness of disinfectant.

-Mixed solution has a shelf life of 24 hours.

-Household bleach is effective against Coronavirus when properly diluted.

Tips:

-Contact surfaces should stay wet to ensure complete disinfecting.

-Be careful with solution – bleach can damage surfaces and discolor material.

-Follow manufacturer instructions for application and proper ventilation.

-Make sure product is not expired.

-Never mix household bleach with ammonia or other household cleaners.

 

Q: What if I need to see my provider but don’t want to risk exposure to the Coronavirus?

Jill Wilkens, MPAS/PA-C: We know that it is still necessary for us to provide care not only for the sick, but for our routine healthy patients as well. You may still need to be seen in certain situations. We are working out a process to find a safe alternative location to take care of our healthy patients. If you feel unsafe coming into our facility, please call and we will do whatever we can over the phone. You can also utilize MyChart and we will take care of you.

Patients also have the option to seek care online through the TCHC eClinic where providers can virtually diagnose, recommend treatment and prescribe medication. (Our eClinic also offers FREE Coronavirus screening)

 

Q: What news sources do you recommend to stay updated and informed on the Coronavirus? What should we do to be prepared?

Dr. Hess: Take care of yourself, eat healthy, stay hydrated, get plenty of rest, get good exercise, and keep an eye out for updated information here or visit Centers for Disease Control and Minnesota Department of Health.


COVID-19: Health Care Workers Answer the Call

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By Susan Marco, Provider Recruitment

My grandmother Ethel was a nurse in Honolulu/Pearl Harbor during World War II. She was sent to nursing school by her Illinois farm family because they thought she would be an old maid based on her heavy-set frame and not being quite the beauty, her sisters were.

The family must have been shocked when little, Ethel Mae, returned from nursing school in Chicago with a tiny waist, full bosom, and her hair styled. It was then that she told her family that she and some of her single friends had taken positions in the exotic-not an official state-tropical oasis known as Hawaii. It was early 1941.

My grandmother was with her friends hiking the lush, dense Hawaiian island mountains on December 7, 1941, because it was a Sunday and they had to go back to work the next day, which happened to be her birthday.

Front Entrance with coronavirus screening tentsThat Sunday, a date that will live in infamy, was a simple Illinois farm girl’s day of fun celebrating an early 23rd birthday and then, everything changed. She was a nurse; and she was called into action.

I think now about my high school senior son, Jack.  He is at home. No prom, no senior slide, no senior anything. I don’t know that he has fully grasped what all of this means; to be frank, I don’t think I have either. Do we have a graduation party? Will I even be able to get the paper plates, plastic forks, napkins to even have a party? Will I be able to get the food? I went to Aldi one day when all of the COVID-19 talk began, and I reached for a tomato out of a flat of tomatoes (probably a flat of 20-25). Just as I was reaching for it, a woman picked up the whole flat and took it.

There were no eggs. There was one package of shredded cheese left. They had a limit on cans of beans.  I stood in the store as if I pushed the Health care workers in PPE set up in the coronavirus screening tentpause button on my television and looked around. What was I missing? Should I be doing this? Did I not get some memo or pay attention closely enough?

I go to work every day just as all health care employees do. I am not an RN like my grandmother; I am not on the essential front line of this virus. I work in an office in the old hospital building where I continue on — continue to work, continue to get up every morning and go to bed every night and continue to show up.

But here is the heart of it all — I show up and do what I can. I take the information that is given to me and I work with it. I go home at night and try to fall asleep and not let the fear and anxiety take over. I get up in the morning, get my cup of coffee and proceed forward. I must trust that the decision makers are making good decisions. I must trust that my co-working providers and nurses have a plan and have the stamina to continue.

We can’t control this — this, being life. We can’t control how the journey switches, changes or alters. We could be hiking one day and be in triage tents in Pearl Harbor the next. We could be an 18-year-old that thinks they have the world by the tail, only to be told there is no end of the senior year, no prom, no senior glory. Yet, the thing is, we are all on this journey together and we need to show up for it.  We can’t control it but we can be present for it. We can take ownership in our part. Perhaps even someday, tell our grandchildren about the event that colored our life’s journey.

About the Author: Susan Marco lives with her husband, Troy, and has two children, Kenzie (21) and Jack (18). Susan enjoys spending time with her family and enjoys reading and writing. Susan also has her own personal blog where she writes about her various experiences as well as tackles the topic of Alzheimer’s, which she knows first-hand in caring for her mother.


COVID-19: Do your part to slow the spread

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Help Slow the Spread of the COVID-19

The World Health Organization has officially declared the Coronavirus (COVID-19) outbreak a global pandemic. Public health officials have urged people who are sick to follow steps to help prevent the spread of COVID-19 in their home and community.

Restrict travel

People with suspected symptoms, which can include fever, cough, shortness of breath and sore throat, should restrict activities outside of the woman with her hand resisting and preventing coronavirus, a virus that causes severe peneumonia leading to death.home, except for getting medical care. Do not go to work, school or public areas and avoid using public transportation, ride-sharing and taxis. REMEMBER: IF YOU ARE DISPLAYING SYMPTOMS PLEASE CALL AHEAD BEFORE VISITING ANY MEDICAL FACILITY.

If you must leave the house, avoid close contact with other people. Keep at a distance of about 6 feet, if possible.

Designate a specific room in the house

People with symptoms should practice isolation from family and animals in the household to limit the risk of spreading the disease. This means having a designated room away from family members and to use a separate bathroom, if available.

Wear a face mask 

If you must leave the house, a face mask can limit the spread of the disease to other people sharing a room or vehicle. Health care facilities will require a mask upon entry of the building. The mask is required to stay on during the entire visit, or you will be asked to leave. This is for the safety of the patients, medical care providers and community.

Cover coughs and sneezes

Always remember to cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can and immediately wash your hands with soap and water for 20 seconds. Alternatively, you may clean your hands with an alcohol-based hand sanitizer that contains at least 60-95 percent alcohol covering all surfaces of your hands until dry. Soap and water should be used if hands are visibly dirty.

Do not share personal household items

Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After use of these items, they should be washed thoroughly with soap and water.

Practice good hand hygieneMan washing hands in an effort to slow the spread of COVID-19.

Now is an especially good time to remind people to clean your hands often. Wash hands for at least 20 seconds with soap and water or use alcohol-based hand sanitizer. Avoid touching your eyes, nose, and mouth with unwashed hands.

Disinfect high touch surfaces daily

Surfaces like counters, tabletops, doorknobs, toilets, phones, keyboards and tablets are all high traffic areas in use every day. It is important to clean each surface daily, especially any that may have blood, stool, or bodily fluids on them. Use a cleaning spray or wipe, according to the label instructions.

Monitor your symptoms

Seek immediate medical attention if symptoms worsen. Call your health care provider before seeking care, and tell them that you have, or are being evaluated for COVID-19. Wear a face mask at all times to keep other people in the office or waiting room from getting infected or exposed.

Follow instructions provided by local health departments.

Discontinuing home isolation

It is difficult to say when it is safe to discontinue home isolation, and this decision should be made on a case-by-case basis. Consult with your health care provider and state and local health departments before ending home isolation.

eClinic

Tri-County Health Care encourages people with symptoms to contact our eClinic for 24/7 online appointments with trusted providers. In addition to providing free COVID-19 Screening, the eClinic helps patients skip the trip and allows providers to recommend treatment and prescribe medication online.

SOURCE: www.cdc.gov


The Coronavirus: Flattening The Curve

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As viruses spread, they tend to infect increasing numbers of people at high rates. The initial side of the curve over time, or rate of new infections, will naturally increase rapidly as more and more people are infected. If left unchecked, the total number people requiring health care will quickly rise well above the capacity of our US health care system.

By taking certain steps – canceling large public gatherings, for instance, and encouraging some people to restrict their contact with others – governments have a shot at stamping out new person-to-person transmissions, while also trying to mitigate the damage of the spread that isn’t under control.

The epidemic curve, a statistical chart used to visualize when and at what speed new cases are reported, could be flattened, rather than being allowed to rise exponentially. “If you look at the curves of outbreaks, they go into big peaks, and then come down. What we need to do is flatten that down,” stated Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “That would have less people infected. That would ultimately have less deaths. You do that by trying to interfere with the natural flow of the outbreak.”

Stop the spread of coronavirus by flattening the curve

The notion that the curve of this outbreak could be flattened began to gain credence after China took the extraordinary step of locking down tens of millions of people days in advance of the Lunar New Year, to prevent the virus from spreading around the country from Wuhan, the city where the outbreak appears to have started.

The quarantines, unprecedented in modern times, appear to have prevented explosive outbreaks from occurring in cities outside of Hubei province, where Wuhan is located.

Since then, spread of the virus in China has slowed to a trickle; the country reported only 19 cases on March 9th. And South Korea, which has had the third largest outbreak outside of China, also appears to be beating back transmission through aggressive actions. But other places, notably Italy and Iran, are struggling.

On any normal day, health systems in the United States typically run close to capacity. If a hospital is overwhelmed by Covid-19 cases, patients will have a lower chance of surviving than they would if they became ill when the hospital’s patient load was more manageable. People in car crashes, people with cancer, pregnant women who have complications during delivery – all those people risk getting a lesser caliber of care when a hospital is trying to cope with the chaos of an outbreak.

“I think the whole notion of flattening the curve is to slow things down so that this doesn’t hit us like a brick wall,” said Michael Mina, associate medical director of clinical microbiology at Boston’s Brigham and Women’s Hospital.

“It’s really all borne out of the risk of our health care infrastructure pulling apart at the seams if the virus spreads too quickly and too many people start showing up at the emergency room at any given time.”

The U.S. has about 2.8 hospital beds per 1,000 people (South Korea and Japan, two countries that have seemingly thwarted the exponential case growth trajectory, have more than 12 hospital beds per 1,000 people; even China has 4.3 per 1,000). With a population of 330 million, this is about 1 million hospital beds. At any given time, about 68% of them are occupied. That leaves about 300,000 beds available nationwide.

Most people with Covid-19 can be managed at home. But among 44,000 cases in China, about 15% required hospitalization and 5% ended up in critical care. In Italy, the statistics so far are even more dismal: More than half of infected individuals require hospitalization and about 10% need treatment in the ICU. As cases spiked, Italian hospitals quickly couldn’t keep up with the patients coming in.

Countries and regions that have been badly hit by the virus report hospitals that are utterly swamped by the influx of sick people struggling to breathe.

Alessandro Vespignani, director of the Network Science Institute at Northeastern University, is gravely worried about what he’s hearing from contacts in Italy, where people initially played down the outbreak as “a kind of flu”. Hospitals in the north of the country, which the virus first took root, are filled beyond capacity, he said.

By limiting exposure to others, also known as “social distancing“, epidemiologists believe the curve could be meaningfully flattened. Social distancing means avoiding contact with others. This is crucial from a global health perspective. Limiting coronavirus cases not only has the obvious benefit of keeping the elderly and vulnerable safe, but it lessens the single biggest public health issue: overwhelmed hospitals.


Pulmonary Rehab: Breathe Easier

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For patients diagnosed with chronic lung conditions such as Chronic Obstructive Pulmonary Disease (COPD), everyday life can be an uphill battle. However, there is hope to manage that diagnosis and it comes in the form of Pulmonary Rehabilitation. Tri-County Health Care’s program helps patients manage their symptoms, complications, oxygen and medications which then reduces hospitalizations and improves quality of life.

Senior sportswoman breathing in fresh air with arm band and headphones outdoors in the parkJackie Mattson, an Exercise Physiologist in the Respiratory Therapy Department at Tri-County Health Care, leads the program and says Pulmonary Rehab can play a vital role in managing chronic breathing problems.

“Our goal is to improve the daily activities in their lives and help our patients learn to manage their diagnosis,” Jackie said.

The Pulmonary Rehab program at Tri-County Health Care combines breathing, exercise and education in order to help patients manage their chronic breathing problems, increase their energy and help reduce breathlessness.

Patients can benefit from Pulmonary Rehab if they have respiratory conditions including: Asthma, COPD, Chronic Bronchitis, Emphysema, Pulmonary Fibrosis, Cystic Fibrosis, lung surgeries, Pulmonary Hypertension or other respiratory diseases.

The program is personalized to fit an individual patient’s needs, but it often consists of 16 sessions across 8 weeks. Each session has an educational component to it, and Tri-County Health Care utilizes their medical experts across multiple fields to help patients.

“We have our patients meet with diabetes prevention, pharmacists, nutritionists and other experts to help provide education on how to best manage their condition,” Jackie said. “We want to make sure our patients have access to this information to help them succeed in our Active senior woman exercising on treadmill during pulmonary rehab sessionsprogram and enhance their quality of life.”

Patients also benefit from learning techniques that will help them gain more control of their breathing and avoid feeling out of breath while being physically active or under stress. These techniques can include yoga breathing or pursed-lip breathing.

Exercise is also a focus of the program. It helps to not only build stamina and flexibility but also strengthens muscles used to breathe. This in turn makes performing everyday tasks easier.

The Respiratory Therapy team uses a variety of exercise equipment such as a treadmill or stationary bike. They monitor heart rates, blood pressure and oxygen levels during exercise and might recommend medication to help keep airways clear and open. Tri-County Health Care also utilizes certain exercises and equipment to help patients with mobility issues benefit from the program.

For more information on how Pulmonary Rehab can be beneficial for you, talk to your provider or call our Respiratory Therapy Department at 218-631-7479.


Strength and Conditioning is key to Injury Prevention

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By Sarah Maninga, Tri-County Health Care Certified Athletic Trainer

The winter sports season continues to wind down and spring is right around the corner. It’s the time of year where athletes transition from the comfort of the gym to the sunshine of the outdoors. That is, if the snow ever melts! While athletes patiently wait for the warmth of spring to come, it’s a crucial time to prepare for the upcoming season. The month of March is not only a bridge between sports seasons, but also National Athletic Training Month! Sports Medicine Providers and Certified Athletic Trainers offer much more than just evaluating and treating injuries.

We can also help prevent injuries in the first place. But, how is that possible?Attractive sports people are strength training with dumbbells in gym

It all starts with strength and conditioning. Most of the people I work with use this for injury prevention. Muscle imbalances and weakness can lead to injuries, so it’s key to get athletes in the weight room in between seasons and in the summer to keep them injury-free. Coaches or physical education teachers open the weight room after school between seasons, and I stop in to help as much as I can.

This training isn’t just for athletes, however, it’s for people of all age groups and activity levels. Programs instead focus on each individuals’ goals and interests to establish a program they will benefit from. Progression will occur as the person is ready to ensure that they continue to see improvements and enhance their overall body strength. Studies show that lean muscle mass decreases as you age, which makes strength and conditioning even more important to your health. Improving balance can be vitally important to fall prevention.

The strength and conditioning programs for athletes expand in the summer months.

At the schools I work with – Wadena-Deer Creek, Menahga and Sebeka – athletes complete hour-long workouts in the weight room, three days a week. We train using a wide range of exercises that focus on the whole body and in addition to conditioning. A major injury we see at the high school level is anterior cruciate ligament (ACL) tears, so we focus on hip and core strengthening along with proprioceptive exercises to try to prevent them. The conditioning exercises we do can range from sprints to plyometric circuit training.

We also do plenty of work on single leg balance exercises to prevent injuries to the ankles and knees, which are common injuries at the high school level. The shoulder is known to be an unstable joint, so we make strengthening it another area of focus.

Adult wstrength training at the gym with a personal trainer and looking very happy - healthy lifestyle conceptsFor those without access to weight rooms, there are many options and tools at your disposal right in your own home. Soup cans or milk jugs can be used as weights while doing exercises. Stairs can be perfect for running up and down for conditioning or step up exercises. If you look around, your home has plenty to offer to assist with workouts!

You can even use your own body weight to do many different exercises. Squats, lunges, push-ups, planks and step ups are just a few common exercises that require no equipment and provide a good workout right in your home.

Athletic trainers wear plenty of hats in our line of work. From high school outreach to injury evaluations to training programs, we aim to help you recover from an injury or help prevent it in the first place. We would prefer to see you happy and healthy. So, whether you are an athlete competing in a state tournament or someone preparing for your first 5K race, we want to emphasize the importance of strength and conditioning.

If you are unsure about starting an exercise program, please consult your provider to make sure it is right and safe for you. To learn more about our Sports Medicine program at Tri-County Health Care, click here.

In the event of an injury, Tri-County Health Care’s Rehab Services can help you regain your strength through services that include Aquatic Therapy, Occupational Therapy, Physical Therapy and Speech Therapy.Athletic Trainer, Sarah Maninga with her family

About the Author: Sarah Maninga has been an athletic trainer at TCHC since January 2015. She works with athletes at three area schools: Wadena-Deer Creek, Sebeka and Menahga. During her time off, she enjoys spending time with her husband and daughter on their small farm and doing anything that involves being outside, especially hunting and running.