The latest news on the heal th and wel lness issues that mat ter most • Jul y 2020 He lthMatters
High-Tech Disinfecting Robots are Working to Make a Safer NCH Hospital Environment
R obotic devices that clean floors and carpets are the norm in many homes. So, it is not that far-fetched that robots are now able to disinfect patient rooms and other hospital areas, with the goal of reducing infection rates and keeping patients safe. Like something out of science fiction, a fleet of ten germ-busting Xenex LightStrike robots, is wiping out bacteria, germs and viruses, including the coronavirus that causes COVID-19, with ultraviolet light (UV). On January 27, the robots made their debut as NCH unveiled the latest high-tech solution for decreasing infection rates, unaware of just how important these robots would become during the pandemic. Unlike the mercury bulbs used to make UV light, the Xenex LightStrike robots made by Xenex Disinfection Services, use bursts of pulsed xenon that penetrate the cell walls of microorganisms like bacteria, viruses, mold, fungus and spores. The intense UV light causes irreparable damage to exposed pathogens, like coronavirus, which effectively kills them, according to Georgine Kruedelbach, NCH Infection Prevention Director. “We still manually clean areas, and now, we use the robot as an extra measure. The room or area is then ready to service the next patient without risk of infection or lingering germs to a degree that ordinary manual cleansing may miss,” she adds. “We have an active antibiotic stewardship program, and the use of the robots is part of a comprehensive program to prevent infections, especially those related to coronavirus and multidrug resistant organisms. We utilize hand hygiene, antibiotic stewardship, education and room cleaning; these robots add another tool to the toolbox.” Initially, NCH environmental staff members trained to use the Xenex robot were using this technology in high-risk areas such as operating
rooms, critical care unit, emergency rooms and patient rooms. As the pandemic intensified, NCH expanded their germ-zapping robot fleet from 3 to 10, made possible by the generosity of several NCH donors (see box below), and are now using the robots in the COVID-19 units, restrooms and other areas of the hospital to eliminate the spread of the coronavirus. Witt Copeland, Regional Director with Xenex explains that for a patient room, three five-minute cycles are used. Since the UV light can only disinfect what it can see, one cycle is used in the bathroom and two in the room. With a five- minute disinfection run, viruses, bacteria
and germ spores can be killed. “We have over 30 published peer reviewed studies and over 10 peer reviewed outcome studies, and we have deployed Xenex robots in over 500 facilities globally,” says Copeland. The latest study conclusively determined that the Xenex robot was effective in killing the coronavirus, which causes COVID-19. NCH hospitals and if you are sick, please feel confident you can come to NCH. Don’t wait,” says Paul Hiltz, President and CEO of NCH Healthcare System. “These robots are “The ten robots can be found throughout both adding an extra layer of protection to our already extensive list of protocols to keep our patients safe.”
Xenex LightStrike robot is effective against these known microorganisms (using various timed cycles):
Features of the Xenex LightStrike robot
• Coronavirus • Ebola • Anthrax • Influenza • MRSA virus • Norovirus • C.diff • Candida albicans • Staphylococcus aureus
• Proven effective against the deadliest pathogens including the coronavirus that causes COVID-19. • Uses intense bursts of pulsed xenon UV light. • Kills deadly pathogens that are invisible to the naked eye. • Destroys infection-causing microorganisms, even in shadowed areas, in minutes. • It is portable and works quickly; dozens of rooms can be disinfected per day with a single robot. • Robots can be used in any department or unit. • Robots are used in 400+ hospitals and facilities globally. • Fewer healthcare associated infections (HAIs) are report
• Staphylococcus epidermidis VRE (vancomycin-resistant enterococci) • CRE (carbapenem-resistant Enterobacteriaceae)
✶ Bill Allyn, Marc Allyn, the Allyn family, 1 robot named “ Pretty Penny ” ✶ Jay and Patty Baker, 2 robots named “ Kizziebot ” and “ Donnabot ” ✶ Jay and Patty Baker, Scott and Simone Lutgert, 1 robot named “ JayScott ”
NCH is so grateful to
these donors who funded and named 10 Xenex robots.
✶ Julia Van Domelen, 1 robot named “ Good Juju ” ✶ Fritz and Kathy Friday, 1 robot named “ Zachary ”
✶ Mike and Noelle Ilitch, 2 robots named “ Angel 1 ” and “ Angel 2 ” ✶ Mariann and Robert MacDonald, 1 robot named “ Gizmo ” ✶ Bruce and BarbaraWiegand, 1 robot named “ GramPa8 ”
For more information, contact NCH Infectious Diseases department at (239) 624-0800
Hands Inside the Body - NCH Acquires The Advanced, 4th Generation, da Vinci Surgical System
Robert Grossman, MD, Brian Solomon, MD, Marc Colton, MD in front of the da Vinci Surgical System
N CH has joined a collection of healthcare which utilize advanced, robotic, computer and optical technologies. Surgeons can now perform complex procedures with precision in a way that surpasses the capabilities of the human hand and naked eye in the areas of systems across the country that currently offer the latest 4th generation da Vinci surgical system — the da Vinci Xi and X Robots,
perform surgery,” he adds. “Previously, open surgery had limitations with the incision healing-time, risk of blood- loss, long hospital stays and recovery, making these surgeries riskier to patients.” The da Vinci surgical system include four robotic “arms,” the operative surgeon’s console where the physician sits and controls arm and hand movements, a patient cart and a vision cart with a high-visual capability monitor. For now, Brian Solomon, MD, NCH cardiovascular and thoracic surgeon, says he is focusing on lung-related robotic procedures. In time, he will also be performing cardiac procedures. “Today, by advancing the standard of care for lung surgery, we are advancing into the future and doing something few other hospitals in the state are doing,” states Dr. Solomon. “The da Vinci Xi Robot allows thoracic surgeons to perform many procedures with small access. We can remove an entire lung with a two- inch back incision and send patients home the next day, reducing the hospital stay from seven days to one day. It’s remarkable.” Furthermore, women can benefit greatly from the advantages of this technology. “The daVinci Xi platform further enhances the gynecologic surgeon’s ability to perform more complicated procedures, all while reducing blood loss, post-operative pain, post operative infection rate, and length of recovery as compared to other surgical approaches,” explains Max Kamerman, MD, Department Chair of obstetrics & gynecology at NCH.
“This state-of-the-art and minimally invasive technology will benefit those patients with large/multiple fibroid tumors, endometriosis, and various forms of pelvic organ prolapse.” “The scope and complexity of procedures and surgeries that can be performed with incredible precision using the da Vinci surgical system, are truly exceptional,” say Drs. Colton, Grossman, Kamerman and Solomon, “and we are happy that patients can benefit from this technology here at NCH so they can get back to the activities they enjoy.”
urology, thoracic and general surgery with the da Vinci Xi, and gynecologic surgery with the da Vinci X. With the da Vinci surgical system, surgeons operate through just a few small incisions using mechanical wrists that bend and rotate to mimic the movements of the human wrist
Dr. Kamerman, MD
allowing the surgeon to make small, precise movements inside the body. As a result, this technology enables your surgeon to operate with enhanced vision, precision and control. Before the advent of robotic surgical techniques, surgeons could utilize a small 2D camera to perform minimally invasive laparoscopic surgeries. However, surgeons could not perceive depth while working laparoscopically. “With the da Vinci Xi Robot, the 3D-HD is highly magnified, so we have a close-up view of the area we are operating on,” explains NCH urologist Marc Colton, MD. Unlike human arms that rotate only 180 degrees, the da Vinci Xi robotic arms can rotate 270 degrees, and are able to dock with a specific area or organ. “I can cauterize tiny blood vessels, sew delicate tissues, and preserve small nerve bundles without any usual intension tremor; it’s like having a very steady hand inside the body,” says Dr. Colton. “With two extra arms and a better set of eyes that allows for better visualization, we have less blood loss and shorter hospital stays,” says Robert Grossman, MD, NCH general surgeon. “Colon surgery has a national average of nine to 11 days of hospital stay; with this technique, I have had patients discharged in 46 hours, with the average stay just three to five days.” “One of the reasons the robot is so revolutionary is because of the decreased amount of time it takes to
Benefits of the da Vinci Robot Surgical System to patients
Types of surgical procedures performed with the da Vinci Xi Robotic-assisted surgery
GYNECOLOGIC SURGERY: ■ Hysterectomy for benign conditions and cancer ■ Pelvic organ prolapse ■ Myomectomy ■ Endometriosis resection THORACIC SURGERY: ■ Procedures from small lung biopsies to large cancer resections
UROLOGY: ■ Kidney procedures ■ Reconstruction and implantation ■ Bladder removal (cystectomy) ■ Prostate removal (prostatectomy) GENERAL SURGERY: ■ Colon resection with reconnection in the body ■ Gastric resections ■ Esophageal procedures ■ Bariatric procedures ■ Abdominal wall hernias (inguinal, incisional, umbilical)
■ Shorter hospital stay ■ Less blood loss ■ Fewer complications ■ Less pain ■ Faster recovery time ■ Smaller incisions associated with minimal scarring
For more information, contact the NCH Heart Institute at (239) 624-1000, or NCH General Surgery at (239) 624-4650, or NCH Urology at (239) 624-1160
The New Doc on the Block – Dr. Adrian Zamora
Launches Family Medicine Practice at NCH Northeast Dr. Adrian Zamora, NCH Physician Group Family Medicine has experienced the medical profession in ways many other physicians have not. While he was working his way toward earning his MD, he spent four years as an EMT, or Emergency Medical Technician, and an additional four years as an ER technician. Therefore, when he went to medical school, he appreciated firsthand how the subject material applied to the real world. “I knew why what I was learning was relevant,” says Dr. Zamora, and that has helped him to be empathetic and see treatment from the patient’s side. His variety of experiences led him to specialize in family medicine, in which he is board-certified. His hands-on training allows him to also offer minor procedures, including cryotherapy, steroid injections, and minor wound care right in his office.
That office is located at NCH Healthcare Northeast at the corner of Collier Blvd and Immokalee Rd in Naples. Dr. Zamora is a native of Chicago, earned his medical doctorate degree from the University of Illinois in Chicago, and completed his family medicine residency at the Loyola-MacNeal Family Practice Residence Program in Chicago. Dr. Zamora’s father came fromMexico, and Dr. Zamora lived in that country for six years while growing up, so he is fully fluent in Spanish as well as in English, making him an ideal choice for treating bilingual or Spanish- speaking patient families. With two small daughters at home, Dr. Zamora is attuned to children, and offers exam rooms equipped to their delight, but also specializes in treating all members of the family. “Being a parent helps you be a good family medicine doctor who takes care of kids,” he adds.
Dr. Adrian Zamora
Dr. Adrian Zamora, MD, NCH Physician Group is accepting new patients at 15420 Collier Blvd in Naples. To schedule an appointment, please call (239) 624-0600
What’s the Difference Between Addiction and Drug Dependence?
“This is a common question and one that is important to clarify," says Dr. Samuel K. Parish, MD, NCH Physician Group Family Medicine/Addiction Medicine. Dependence on a drug implies the physiologic changes that occur with regular use and predictable symptoms
drug are often unsuccessful,” says Dr. Parish. He explains that a good example of the difference between addiction and dependence is in babies born to mothers who have used
substances during pregnancy. There has never been a baby born an ‘addict’. If a mother uses substances such as opioids, benzodiazepines, cannabis, some antidepressants, tobacco products, or alcohol, the baby may develop symptoms of withdrawal after birth. This indicates dependence on the substance but not addiction. The baby shows no craving,
of withdrawal if the drug is discontinued. Dependence can occur with prescription drugs such as benzodiazepines for anxiety and opioids for pain control even when used appropriately as prescribed. Chronic diseases such as hypertension and diabetes mellitus may be dependent on medications for management, but those medications do not have withdrawal symptoms when discontinued, although the condition may worsen. Addiction is defined as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use despite adverse consequences. Addiction is characterized by craving to use the drug knowing the potential negative outcomes. Over time, the drug is taken in larger amounts to have the same effect and to avoid symptoms of withdrawal. Impairment in control over drug use affects personal and work life and relationships. “Continued use leads to risk-taking behaviors and attempts to reduce or stop the
Dr. Samuel Parish
compulsive drug seeking, risky behavior, or impaired control. The word ‘addict’ carries a great deal of stigma in our society and it should never be used when referring to a baby. “In summary, addiction involves dependence on a drug, but all drug dependence does not involve addiction,” notes Dr. Parish.
Dr. Samuel Parish’s offices are located at 800 Goodlette-Frank Rd., Suite 310, Naples. For more information, or to make an appointment, call 239-624-0870
NCH Welcomes New Breast Health Specialist
N CH recently professionals. Tran Ho, DO, a breast surgical oncologist, began her tenure with NCH last fall, bringing her expertise in the detection and treatment of breast cancer, oncoplastic breast surgery, and high-risk evaluation to the NCH Center for Breast Health. welcomed a new star to its stellar team of breast healthcare
cases to develop evidence-based and optimum care plans for each patient. In an effort to round out the spectrum of breast health care offered at NCH, Dr. Ho and the team at the Center for Breast Health are developing a survivorship care clinic or program for patients who have been treated for breast cancer. “It’s the next chapter in their lives in terms of moving forward with a new normal after breast cancer treatment and understanding the follow-up that is needed. It is important for us to help be that bridge in this next step in their lives,” says Dr. Ho, who also has an eye on making the Center for Breast Health a destination for breast care. “We recognize that there is a large seasonal population of patients who come to Naples,” says Dr. Ho. “We want
Services provided by Tran Ho, DO:
• Breast-conserving surgery • Nipple-sparing mastectomy • Prophylactic mastectomy • Oncoplastic breast surgery • Breast ultrasound and biopsies • Image-guided breast procedures • Breast cancer risk assessment • Genetic testing
“We evaluate and treat patients with a variety of breast issues – both benign and malignant,” explains Dr. Ho. “We treat women and men with breast cancer, benign breast masses, nipple discharge and other breast concerns, as well as providing compassionate care to these patients.” Fellowship-trained in Breast Surgical Oncology, Dr. Ho graduated from Atlanta’s Emory University and received her medical school training at Touro University of Nevada. She completed her general surgery residency at Genesys Regional Medical Center in Michigan and is a member of the Society of Surgical Oncology and the American Society of Breast Surgeons. Committed to bringing excellence in healthcare to her patients, Dr. Ho is part of a multidisciplinary team that provides efficient and comprehensive care for breast cancer patients. This team includes oncology nurse navigators, medical oncologists, radiation oncologists, radiologists, pathologists, and breast surgeons who meet weekly at a breast tumor board to discuss patient
Tran Ho, DO
seasonal and permanent residents to know that they can receive advanced breast care at the Center for Breast Health in Naples – if there is a breast concern, come in and see us and we’ll take care of you.” For more information, or to schedule an appointment, call (239) 624-8120. Dr. Ho’s office is located at NCHCenter for Breast Health, 11181 Health Park Blvd., Ste. 2220, in North Naples.
New Half-Dose Radiation Mammogram Screenings Offer Lower Exposure to Radiation with Excellent Detection
in units called millisieverts, or mSv. Medical imaging does indeed expose patients to some radiation, the amount of exposure depends on the type of imaging being performed. A typical chest x-ray, for example, will expose a patient to about 0.1 mSv – or the equivalent of 10 days of natural background exposure. A CT scan, on the other hand, ups that exposure level to 10 mSv, and a PET scan, to 25 mSv. These tests are not intended for yearly annual screening. The annual mammogram radiation exposure is designed to be lower than CT scans and is roughly equivalent to seven weeks of background radiation, or summering in high elevations such as Colorado, or taking 10 domestic flights in a year. Screening mammograms make up
to 1 mSv with the newer and more accurate 3D mammogram. “The increase in dose is worth it, as we realize that the 3Dmammogram findsmore cancers,” she adds, “and 2D+3D mammograms are still well below published Mammography Quality Standards Act (MQSA) mandated guidelines.” In an effort to lower radiation exposure from the 3D mammogram, now a computer software is used to synthesize a 2D mammogram from the 3D images – or create a composite view – of the breast without exposing the patient to additional radiation,” explains Dr. Handa. The American Cancer Society recommends annual mammogram screenings for all women at age 40. “If you have been putting off mammograms, the time is now to make an appointment for this most important screening exam,” stresses Dr. Handa. Benefits of the new lower dose radiation protocol with 3D imaging
Dr. Priyanka Handa
only a small fraction of the total radiation we are routinely exposed to. A mammogram is a voluntary step to detect cancer before it can be felt, and the benefit of early diagnosis far outweighs any risk of radiation. “NCH imaging has cut the radiation dose of a typical 3D mammogram in half, while maintaining excellent diagnostic accuracy,” says Priyanka Handa, MD, Director of Breast Imaging at NCH Imaging Centers. “The annual exposure limit of a radiation worker is up to 50 mSv per year, and they have zero increased risk of cancer, even with daily workplace exposure.” Dr. Handaexplains that traditional 2Dmammogram delivers up to 0.5 mSv of radiation, which increases
Breast cancer is very treatable when it is caught in its earliest stages. As more women participate in yearly mammography screenings, mortality rates continue to fall. Radiation can be a small cause for concern for some, but here are the myths and realities of medical radiation exposed. It is true that high levels of radiation can cause tissue damage and cancers. However, rarely are these conditions attributable to radiation exposure during diagnostic imaging tests. We are all exposed to varying levels of natural radiationeveryday, thanks to cosmic rays, radon gas in our homes and radioactive materials in our environment. These are all naturally occurring sources of radiation, which aremeasurable
✦ Reduced radiation in half of the typical 2D +3D exam ✦ 3D mammograms find more invasive cancers and improves the cancer detection rate ✦ 3D mammograms have a lower recall rate, with fewer women required to return for additional imaging
NCH Imaging is the largest imaging service in Collier County with 5 convenient locations offering 3Dmammogram. For more information or make an appointment, call (239) 624-4443 to schedule a mammogram.
Preventing Stroke:
Eating
Healthy EATING HEALTHY FOODS helps lower cholesterol and reduce plaque buildup in arteries. It can also help you lose weight and keep high blood pressure under control. Eating better doesn’t necessarily mean going on a special diet, unless you have diabetes or high blood pressure. Instead, the idea is to make healthier choices by limiting foods and ingredients that contribute to risk factors for stroke.
Dairy Instead of: • Whole milk • Regular cheese and mayonnaise • Ice cream • Butte r Try: • 1% or skim milk • Low-fat cheese and mayonnaise • Low-fat yogurt • Olive or canola oil • Nuts, seeds, air-popped popcorn • Fresh fruit, whole grain raisin bread Grains Instead of: • White bread • White rice • Regular pasta or noodles Try: • Whole grain bread • Brown rice • Whole grain pasta or noodles Meats Instead of: • Beef and other red meats • Hamburger • Processed lunch meats Try: • Fish, skinless chicken, or tofu • Ground turkey • Chicken or turkey breast slices Sweets and Snacks Instead of: • Soda pop • Chips and other salty snacks • Donuts and croissants Try: • Water
Choose fats wisely Reducing “bad” fats in your diet helps keep your arteries healthier. Use this guide: ● Choose unsaturated fats. These are found in foods such as fish, nuts, olive oil, canola oil, and avocados. In moderation, these fats can be good for you. ● Limit saturated fats. These are found in meat and dairy foods, such as burgers, poultry skin, milk, cheese, and butter. ● Avoid trans fats. These are often found in processed foods. Avoid any food that has the word “hydrogenated” in its ingredients. Reduce sodium (salt) You may be asked to eat less sodium (mainly found in salt). If you have high blood pressure, your healthcare provider will probably recommend that you limit your sodium intake to 1,500 mg to 2,400 mg per day. Use these tips: ● Look for food labels that say “salt free” or “very low sodium.” Always check for the number of servings per container on the food label, as a container of food may have more than 1 serving. ● Avoid canned and packaged foods such as canned soup, instant noodles, TV dinners, and premade sauces. ● Don’t add salt or soy sauce to meals. Use fresh herbs or lemon juice for seasoning. Your taste buds will adjust. ● Avoid fast food. Look for “heart healthy” items on restaurant menus. These are often lower in fat and salt. For family and friends Good eating habits are easier when everyone joins in. ● Help shop for healthy foods. Choose lots of fresh fruits and vegetables. ● It’s most helpful if everyone in the family eats healthy foods.
Choose the right mix of foods The key to good eating is having a variety of healthy foods. Try to plan meals around vegetables, fruits, lean meats, and whole grains. Limit fatty meats and high-fat dairy products. The chart below can show you the best way to fill up your plate.
1. Drink water or low-fat (1% of fat-free skim) milk with meals. Avoid sugary sodas and salty vegetable juices. 2. At least half the plate should be vegetables and fruits. Limit fatty toppings, such as butter, salad dressing, and sour cream.
3. No more than one-quarter of the plate should be meat or other protein. Fish, beans, tofu, and lean cuts of poultry are best. Bake or broil meat instead of frying. 4. About one-quarter of the plate can be starchy foods, such as rice and potatoes. Whole grains, such as brown rice or whole wheat bread, are best. Try healthier options Giving up old food habits doesn’t have to be hard. Encouragement makes it easier to stick with a healthy eating plan. Here are some easy ways to choose healthier options:
Source: The Staywell company retrieved from Krames
NCH Receives Highest Achievement Award for Comprehensive Stroke Care
NCH received the American Heart Association (AHA) "Get with The Guidelines - Stroke Gold Plus Achievement Award with Target: Stroke Honor Roll Elite Plus” for 2016, 2017, 2018, 2019
NCH is a Joint Commission designated Primary Stroke Center
NCH is designated as a Comprehensive Stroke Center through the Agency for Health Care Administration (ACHA)
NCH and the NCH Physician Group
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Anna Juncadella, MD Rajeev Prabakaran, MD Kunal Suryawala, MD
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Infectious Disease Sergey Akimov, MD Gary A. Bergen, MD Vato Bochorishvili, MD Mark A. Brown, MD Miguel Madariaga, MD Rebecca Witherell, MD Internal Medicine Susan Best, DO Louis Dusseault, MD Giuseppe Guaitoli, MD Kim Hamilton, MD Jeffrey Howland, MD
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Michelle Nowak, APRN Family Medicine Andrew M. Bernstein, DO Christian O. Beskow, MD
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Pedro Martin, MD Bryan Murphey, MD
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For an appointment with a physician, please call (239) 624-8106 Consult with a healthcare provider 24/7 from anywhere in Florida for only $45, visit NCHmd.org/VirtualCare to start your treatment.
NCH Baker Hospital Downtown NCH Downtown Naples Hospital: 624-5000 Academic Internal Medicine Clinic: 624-0940 Business/Occupational Health: 624-4630 Community Blood Center: 624-4120 Dr. John N. Briggs Wellness Center: 624-2750 Emergency Department: 624-2700 NCH Heart Institute: 624-4200 NCH Imaging: 624-4443 Outpatient Cardiac Rehabilitation: 624-1680 Outpatient Infusion Services: 624-4370 Outpatient Oncology Navigator: 624-4988 Outpatient Rehabilitation Center: 624-1600 Palliative Care Clinic: 624-8490 vonArx Diabetes & Nutrition Health Center: 624-3450 NCH North Naples Hospital Campus NCH North Naples Hospital: 624-5000 Emergency Department: 624-9199 Center For Breast Health: 624-8120 NCH Imaging: 624-4443 NCHWound Healing Center: 624-0630 Outpatient Pulmonary Rehabilitation: 624-6800 Pediatric Emergency Department: 624-5000 The BirthPlace: 642-6110 The Brookdale Center: 624-5722 NCH Marco Island Campus Marco Urgent Care Center: 624-8540 Outpatient Cardiac Rehabilitation: 624-8590 Outpatient Pulmonary Rehabilitation: 624-8595 Outpatient Rehabilitation Center: 624-8580
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NCH Healthcare Bonita Emergency Department: 624-6900 NCH Imaging: 624-4443 NCH Healthcare Northeast Emergency Department: 624-8700 Outpatient Rehabilitation Center: 624-8790 NCH Imaging: 624-4443 NCH Healthcare Southeast NCH Immediate Care: 624-8220 NCH Sleep Center: 624-8220 Outpatient Rehabilitation Center: 624-1900 NCH Imaging: 624-4443
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Outpatient Rehabilitation Center: 624-0970
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For information on any of the NCH Healthcare System services, please call 624-1999 or visit us online at www.NCHmd.org
The NCH Health Matters is a bi-monthly publication of the NCH Healthcare System. Every effort is made to ensure information published is accurate and current. NCH cannot be held responsible for any consequences resulting from omissions or errors. NCH Healthcare System, 350 7th Street North, Naples, FL 34102, Telephone: (239) 624-5000, www.nchmd.org
SAFETY IS AT THE CORE OF QUALITY PATIENT CARE
As we adapt to a new normal, please follow these safety precautions:
1 Continue to practice safe social distancing
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Continue to wear your masks or face coverings
Continue to diligently wash your hands
To learn more about how NCH is keeping our staff and patients safe, visit nchmd.org/safety
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