Viruses constantly mutate as they spread, and SARS-CoV-2 is no exception. New variants have emerged globally, some of which spread more easily or may evade immune protections. While vaccination and continued safety measures are critical to slowing transmission, an increase in cases from a more transmissible variant could still overwhelm hospitals. Ongoing genomic surveillance of variants and strict adherence to public health guidelines remain essential to reduce the virus's opportunities to evolve.

2. One thing we know for sure about SARS-CoV-2, the virus that causes
COVID-19, is that it is changing constantly. Since the beginning of the
pandemic, we’ve seen a number of prominent variants, including Alpha,
Viruses constantly change through mutation and sometimes these mutations
the virus.
Although new variants are an expected part of the evolution of viruses,
surfaces is essential in ensuring we—in the U.S. and globally—are prepared.
new variant is more aggressive, highly transmissible, vaccine-resistant, able
disease—or all of the above, compared with the original strain of the virus.
Some variants spread more easily and quickly than other variants, which may
COVID-19. Even if a variant causes less severe disease in general, an
of cases could cause an increase in hospitalizations, put more strain on
potentially lead to more deaths.

3. STRICT
MEASURES
CRITICAL TO
SLOW
SPREAD OF
THE
DISEASE
Mask mandates
Social Distance
Curfews
Limiting number of people who
gather indoors
Closure of open venues
Stay home if sick
Quarantine/Isolate if COVID-19
Vaccine administrations
Herd immunity
Hand washing

4. COVID-19 is spread in 3 ways according
to the experts:
1.By breathing in air when close to an
infected person who is exhaling small
droplets and particles that contain the
virus
2.Having these droplets and particles land
on the eyes, nose, or mouth
3.Or touching the eyes, nose, and mouth
with hands that have the virus on them.
The more closely you interact with others and
the longer that interaction, the higher the risk
of COVID-19 spread, and indoor spaces are

5. THE
STONE
CENTER
MINIMIZING
THE RISK

6. Appropriate Use of PPE
• Hand Hygiene before putting on
PPE and after removal of PPE
• Donning: gown, KN95 or mask,
face shield/goggles, gloves,
bouffant cap as indicated
• Doffing: gloves, gown, face
shield/goggles, mask or KN95
• Optimizing PPE usage
Daily inventory
Limited reuse of KN95s if shortage
Maintain allocations

7. CDC VIDEO | DONNING & DOFFING PPE

8. PROPER REMOVAL OF GLOVES

9. OSHA VIDEO | Proper Mask Use

11. CLEANING AND
DISINFECTION
IS EVERYONE’S JOB!

12. Cleaning and Disinfecting:
A 2 Step Process
• Cleaners or detergents are products that remove soil, dirt,
dust, organic matter, and germs (like bacteria, viruses, and
fungi). Cleaning is necessary to remove dirt that can prevent
disinfectants from working.
• Disinfectants are chemical products that are used to kill germs
in healthcare settings. Disinfecting kills germs on surfaces. By
killing germs on a surface after cleaning, it can further lower
the risk of spreading infection. The disinfectant’s label should
have a list of germs that the product can kill. Use an EPA-
approved disinfectant against COVID-19.
• Cleaning and Disinfection Technique:
√ Progress from cleanest to dirtiest areas, from higher to lower levels and
done systematically
√ Use fresh cloth at start of each cleaning session
√ Discard cloth if no longer saturated with solution

13. REFERENCE GUIDE FOR CLEANING AT THE STONE CENTER
 ALL EPA
APPROVED TO
FIGHT COVID-19
 FOLLOW
CONTACT TIMES
TO BE
EFFECTIVE
CAVI WIPES**
Contact time:
2 minutes
SARS-CoV-2 (COVID-
19) Contact time: 2
minutes
CAVI WIPES**
Contact time:
2 minutes
SARS-CoV-2 (COVID-19)
Contact time:
2 minutes
SUPER SANI
CLOTH
Contact time:
2 minutes
SARS-CoV-2
(COVID-19)
Contact time:
1 minute
GERMICIDIAL
BLEACH WIPES:
Contact time:
3 minutes
SARS-CoV-2
(COVID-19) Contact
time:
30 seconds
70% ALCOHOL
Contact time:
30 Seconds
SARS-CoV-2
(COVID-19)
Contact time:
5 minutes
SANI CLOTH AF
Contact time:
3 minutes
SARS-CoV-2
(COVID-19)
Contact time:
3 minutes
PENTA WIPES
Contact time:
2 minutes
SARS-CoV-2
(COVID-19)
Contact time:
TROPHON
COMPANION
CLEANING WIPES
Contact time: 4
minutes ↓
SARS-CoV-2
(COVID-19)
Contact time:
4 minutes
CAVICIDE
SPRAY on
Lint Free
Cloths
Contact time:
2 minutes
SARS-CoV-2
(COVID-19)
Contact
time:
2 minutes
Medication area Cysto table/pads
Accu Check
Machine
B/P Cuff
ESWL table
therapy head
CLEANING↓
Trophon Drying
Wipe
↓
Neptune
Rover
Stretchers Laser Litho
(Use BP shield –
protect patient
from BP cuff
touching skin – no
patient contact)
Cardiac monitor
UroNav Sensor
Wire
Ultrasound
Transducer
Trophon EPR
High Level
Disinfection
Bedside trays
GLL pedals Anesthesia
circuit holder
DISINFECTING
With
CAVIWIPE↓
Prostate probe
↓
IV Poles
ESWL Table /Pads
^Defibrillator
on Crash Cart &
Accessories
Monitors
(cardiac, pulse
O2,CO2)
Ultrasound
Transducer
Trophon Drying
Wipe
Folding Chairs Anesthesia Cart Laser glasses
B/P cords Anesth. Machine
EKG monitors Skytron 3100 Table
Bedside O2, suction Ultrasound/UroNav
Touch Surfaces
Phones, doorknobs,
light switches, etc.
^Defibrillator on Crash
Cart & Accessories
**Contact time: 3 minutes to kill TB; Pseudomonas Aeruginosa, Salmonella Enterica, Staph Aureus; T. mentagrophytes 10/2018; Revised 5/2020; Revised 6/2020; Revised 10/2021
^CaviWipes or Sani Cloths can be used on Defibrillator on Crash Cart with accessories as per IFU

14. Cleaning
and
Disinfecting
High Touch
Surfaces
High touch surfaces include:
• Door handles, refrigerator handle
• Horizontal surfaces: desks, counters in
lounge, counters in RR, table in staff
lounge, etc.
• Phones/Cellphones/keyboards
• Pens
• Screening thermometers
• Chairs in lobby/lounge/RR/ESWL
• Patient changing area and locker

15. Cleaning
and
Disinfecting
Between
Patient Use
Procedure Rooms & Recovery Room
Patient Equipment and Medical Equipment:
• Anesthesia cart and equipment (IV poles and pumps)
• Anesthesia machine
• Patient monitors
• Patient cart
• Procedure table
• Positioning devices
• Reusable table straps
• Patient transfer devices
• Stretchers/Tables
• Other equipment: e.g.
 Suction regulators
 Imaging monitors
 Lead aprons
 Laser goggles
 Touch surfaces (phones, doorknobs, light switches)
• Floors and wall is soiled with splash or spray

16. COVID -19 TESTING AND QUARANTINE
ALL UNVACCINATED PATIENTS AS PER NJDOH REGS MUST HAVE:
• COVID-19 TEST before the procedure
Any specimen collection method (e.g., swab or saliva or antigen) is acceptable.
The test performed by the laboratory must be a nucleic acid amplification test (PCR) and be
either approved by the (FDA), authorized by the FDA through an Emergency Use Authorization,
or approved by the New Jersey Clinical Laboratory Improvement Services as permitted by the
FDA.
• Only patients with a negative result can be treated at the Center.
• Patients without a current test will not be treated at the Center.

17. COVID-19 TESTS
• Only SWAB or SALIVA or ANTIGEN Tests are allowed:
SARS-CoV-2 RNA COVID-19
SARS-CoV-2 RT-PCR
SARS-CoV-2 NAA
SARS-CoV-2 NAA QL
SARS-CoV-2 RNA
SARS-CoV-2 Antigen
• NO ANTIBODY TESTS ARE ALLOWED
SARS-CoV-2AB (ANTIBODY)

18. COVID-19 TESTS DEFINED
• Antigen test is a lateral flow immunochromatographic assay intended for the
qualitative detection of the nucleocapsid protein antigen from SARS-CoV-2 in
nasopharyngeal or anterior nasal swab specimens.
Referred to as a Rapid Test because test results are determined within 10
minutes
Positive or Negative result
Point of Care Test
• Waived Test performed at The Stone Center
Nurses are trained and Competency performed
Quality Control done as indicated
 Antigen Tests performed at The Stone Center are reported to the NJDOH
Communicable Disease Reporting and Surveillance System (CDRSS)

19. SCREENING OF PATIENTS
• Pre procedure call and Simple Admit have COVID-19 Screening
• In addition, all patients/visitors will be screened at door prior to
entering (COVID-19 Screening Tool)
• All patients/visitors entering TSC will have a temperature check:
Patients with a temp of 100◦F or greater will be cancelled. Visitors
with a temp > 100◦F will not be allowed entry.
• All patients/visitors must wear a mask before entering TSC. This will
be provided by TSC.
• Visitors (family) will not be allowed in TSC except for minors and for
patients who require assistance, legal guardians, special request, etc.

20. Screening of
Staff
Staff are required to self-screen DAILY for:
ALL staff have signed
an ATTESTATION to
do this symptom
screen before work

21. COVID-19 VACCINATION REQUIREMENTS: PATIENTS
Following NJDOH Executive Directive 20-016
Patients are exempt from COVID-19 testing and self-quarantine if the patient:
• Provides proof of full COVID-19 vaccination -2 weeks after their second dose
in a 2-dose series or 2 weeks after a single-dose vaccine.
J&J, Pfizer or Moderna Vaccine
Or one of the WHO approved vaccines (Sinovac, AstraZeneca, Covishield, Sinopharm)
Copy of the vaccination card or NJ vaccination docket, etc. must be presented to be
included on the patient’s Medical Record.
• Has tested positive for SARs-COV-2 within the last 90 days and completed the
appropriate isolation and is currently asymptomatic
• Patients who are not fully vaccinated will have SARS-CoV-2 Antigen Test
performed at The Stone Center
• Vaccine questions and instructions included in Simple Admit and in
Pre Procedure Call

22. COVID-19 VACCINATION REQUIREMENTS: STAFF
Following NJ Executive ORDERS 252 & 290
Staff should be full vaccinated which includes a booster by April 11, 2022
• Provides proof of full COVID-19 vaccination -2 weeks after their second dose
in a 2-dose series or 2 weeks after a single-dose vaccine and 3rd Booster dose.
J&J, Pfizer or Moderna Vaccine
Copy of the vaccination card or NJ vaccination docket, NJ Immunization Record must
be presented to be included for Personnel Record.
• Has tested positive for SARs-COV-2 within the last 90 days and completed the
appropriate isolation and is currently asymptomatic
• Staff who are not fully vaccinated will undergo screening testing at minimum
one to two times each week and submit proof of a COVID-19 test
Either a COVID-19 PCR or Antigen Test

23. Universal Masking
• Everyone in TSC MUST wear a mask at ALL times.
• Facemasks are provided by TSC for patients and visitors.
• Clinical staff must wear a surgical mask provided by TSC.
• Patients and visitors will not be allowed in the building without a
mask.
• Patient will be asked to wear a mask when coming to TSC and then
given a surgical mask upon entry to TSC.

24. Social Distancing
• Limit number of chairs in waiting room
• Limit chairs in lounge
• Staff will follow social distancing throughout their
workday in the Center where applicable
(i.e. workstations, lounge).
Break times and lunches will be staggered
• Scheduling of procedures will be coordinated to
promote social distancing

25. HAND WASHING
• Follow CDC guidelines for Hand
Washing
• Wash hands:
Arrival to work
When visibly soiled
Before eating
After using rest room
After exposure t to C-diff
If soiled with blood/drainage, etc.
• Can use hand sanitizer when
hands are not visibly soiled.
• Gloves

26. HAND SANITIZER
Can use hand sanitizer when
hands are not visibly soiled:
Before direct contact with patient
After contact with patient’s intact
skin( taking pulse, BP, lifting, etc.)
After removing gloves
Using hand sanitizer done the
same way as washing hands

28. RESPIRATORY
PROTECTION
PROGRAM
• All staff must get fit tested
to wear the N-95/K-95 in
times of non Emergency
as per OSHA regs
oCertified Fit Tester will
perform evaluation on staff
who need to wear N-95/K-
95 masks

29. MANAGEMENT OF SUPPLIES
• Monitor PPE use for optimizing PPE in preparation of new
wave/surge of COVID-19 in NJ
Daily inventory of PPE(Burn Rate Calculator)
Daily PPE handout to prevent theft
Seven (7) day minimum supply of PPE on hand
Maintain Allocations
• Monitor other supplies – cleaning wipes, meds, etc.
• Monitor COVID-19 Testing
Reagent, swabs
Testing time
SURGES IN OTHER PARTS OF THE US AFFECT OUR SUPPLIES

30. PATIENT DISCHARGE
Patient discharge policy has not changed
Follow-up phone call post procedure
7-day text

31. AFTER EXPOSURE TO COVID-19
• MINIMAL RISK if wearing
proper PPE
• Staff will self monitor for
symptoms before work.
• Any staff with
community/personal exposure
need to let TSC know for
guidance to either monitor or
quarantine.
• TSC follows CDC & NJDOH
guidelines for COVID
healthcare exposure.

32. COVID-19 EXPOSURE/INFECTION
EXPOSURE IS
• Person was symptomatic or became positive within 48 hours of your contact
• Contact with person for >15 minutes in 24-hour period (15 minute total could be three, 5 minute exposures in 24
hours )
• And <6 ft away from the person
• No masks on
• Negative COVID-19 Test – if tested
INFECTION IS
• Have symptoms of COVID-19 (i.e., fever or chills, cough, shortness of breath, runny nose, congestion, headache,
fatigue, muscle & body aches, sore throat, nausea & vomiting, diarrhea, etc.,)
• Positive COVID -19 Test (Antigen, Rapid PCR, PCR)