Memorandum: Updated – Moving Forward: Guidance for Resumption of Procedures for Non-Urgent and Elective Indications & PPE in Ambulatory Care Settings 

Please see attached memorandum “Updated – Moving Forward: Guidance for Resumption of Procedures for Non-Urgent and Elective Indications & PPE in Ambulatory Care Settings.”

1. The purpose of this memorandum is to provide updates to ”Moving Forward: Guidance for Resumption of Procedures for Non-Urgent and Elective Indications” and “Personal Protective Equipment (PPE) in the Ambulatory Setting” document dated May 22, 2020.
2. Significant updates included in Personal Protective Equipment (PPE) in the Ambulatory Setting, v2 include:
   1. Updating VA’s risk stratification to a community-based transmission model, which is in alignment with CDC’s most current guidance;
   2. Updating PPE guidance table
   3. Adding sections on COVID-19 Risk Stratification for PPE
   4. Updating the definition of procedures that are high risk for disease transmission, to align with CDC’s current guidance
   5. Adding the following appendices:
      1. Appendix A: Recommendations for Veterans, Visitors, or Employees Declining a Mask or Face Covering
      2. Appendix B: General Use of Powered Air Purifying Respirators (PAPR)
      3. Appendix C: Additional Guidance for Operating Room (OR) Procedures
3. Significant updates included in Moving Forward: Guidance for Resumption of Procedures for Non-Urgent and Elective Indications, v2 include:
   1. Parallel updates to those listed in 2 above for PPE risk stratification, definition and table of procedures that are high risk for disease transmission, and guidance of PAPRs and OR procedures.
   2. Updates were made to the guidance on pre-procedure testing and the environment of care guidance.
4. This “Updated – Moving Forward: Guidance for Resumption of Procedures for Non-Urgent and Elective Indications” memorandum and attachments replace the previous version memorandum dated May 22, 2020.
   1. VA’s Moving Forward Together Plan provides an overarching roadmap for reopening VA facilities. The attached Guidance for Resumption of Procedures for Non-Urgent and Elective Indications provides operational guidance that balances the risks of the ongoing pandemic with the risk of potential harm to Veterans from postponement of procedural care.
   2. The Guidance for Resumption of Procedures for Non-Urgent and Elective Indications provides minimum considerations for procedural care during the COVID19 pandemic and should be tailored to individual VA Medical Centers and VISNs. This guidance will be updated as new information emerges and is based on the most recent VHA guidance regarding PPE in the Ambulatory Care Setting.
5. Should you have questions regarding this memorandum, please send an email to the COVID-19 Resource Room.

Attachments: (3)

09172020 — Updated Moving Forward Guidance for Resumption of Procedures for Non-Urgent

09172020 — Moving Forward Guidance for Resumption of Procedures for Non-urgent and Elective Indications_2.0_FINAL

09172020 — Moving Forward_PPE Ambulatory Care Settings_2.0_FINAL