Guidance and responses were provided based on information known on 3/19/2020 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and NE DHHS guidance for updates. COVID-19 and LTC March 19, 2020
CMS Guidance – update 3-13 Facilities should restrict visitation of all visitors and non- essential health care personnel, except for certain compassionate care situations, such as an end-of-life situation. Facilities are expected to notify potential visitors to defer visitation until further notice(through signage, calls, letters, etc.) CDC website has templates . . . Other interventions: 1. Cancel communal dining and all group activities, such as internal and external group activities. 2. Implement active screening of residents and staff for fever and respiratory symptoms. 3. Remind residents to practice social distancing and perform frequent hand hygiene. 4. Screen all staff at the beginning of their shift for fever and respiratory symptoms. Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and self-isolate at home. Nursing homes with residents suspected of having COVID-19 infection should contact their local health department. See complete document at the link below https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf.
Admissions Nursing homes should continue to admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was/is present, and the patient had no exposure risk from that hospitalization. Also, if possible, dedicate a unit/wing exclusively for any residents coming or returning from the hospital. This can serve as a step-down unit where they remain for 14 days with no symptoms (instead of integrating as usual on short-term rehab floor, or returning to long-stay original room). https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf.
When should a nursing home accept a resident who was diagnosed with COVID-19 from a hospital? A nursing home can accept a resident diagnosed with COVID-19 and still under Transmission-Based Precautions for COVID-19 as long as the facility can follow CDC guidance for Transmission-Based Precautions. If a nursing home cannot, it must wait until these precautions are discontinued. Facilities must assess the level of care needed for the COVID-19 positive resident before admission. Ensure you can provide all therapies in light of the patient being confined to their room for an extended time period… some therapies may not be appropriate, such as nebulizer treatments or CPAP, when resident is positive. https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf.
Surveillance Facilities should be monitoring residents frequently throughout the day for potential symptoms of respiratory infections. Consider doing vitals more frequently, including pulse oximetry. They should contact their local health department if they have questions or suspect a resident of a nursing home has COVID- 19. Per CDC, prompt detection, triage and isolation of potentially infectious residents are essential to prevent unnecessary exposures among residents and healthcare personnel. • Move patient to private room with private bathroom. Keep door closed. • Implement Contact/Droplet precautions • Contact your local health department https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf.
Cohorting Residents and Staff If cases of COVID-19 begin to escalate within your facility, cohorting residents with symptoms of respiratory infection may become necessary. With the implementation of cohorting residents, you would also be dedicating HCP to work only on affected units – you should identify NOW an area where affected residents can be moved if this becomes a necessary intervention. https://paltc.org/sites/default/files/Active%20Screeningv1_03.16.20.pdf
Potential need for transfer The resident may develop more severe symptoms and require transfer to a hospital for a higher level of care. Prior to transfer, emergency medical services and the receiving facility should be alerted to the resident’s diagnosis, and precautions to be taken including placing a facemask on the resident during transfer. If the resident does not require hospitalization they can be discharged to home (in consultation with state or local public health authorities) if deemed medically and socially appropriate. Pending transfer or discharge, place a facemask on the resident and isolate him/her in a room with the door closed. https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf.
When to discontinue precautions Positive COVID-19 patients with severe illness may continue to shed virus a number of days after symptom onset. The decision of when a positive patient no longer requires isolation precautions should be made on a case-by-case basis and in consultation with public health officials. Such a decision will need to take into account the severity of the illness, comorbid conditions, resolution of fever, and clinical status of the individual. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html
Testing Priorities Inpatients with a clinical presentation consistent with COVID-19, after ruling out alternative diagnoses (negative RPP), should be considered for testing. Highest testing priority Outpatients that are members of vulnerable or high-risk populations with a clinical presentation consistent with COVID-19, after ruling out alternative diagnoses (negative flu and RPP), should be considered for testing. Vulnerable or high-risk populations include o Healthcare workers o Public safety (EMS, law enforcement, firefighters) o Nursing home, group home, daycare attendees or employees Most outpatients with a clinical presentation consistent with COVID-19 WITH A CLINICALLY CONSISTENT PRESENTATION should be considered a probable case of COVID-19 and self-isolate without expecting testing. Testing to rule out an alternative diagnosis is up to the PCP.
Monitoring and Work Restrictions HCP in the high- or medium-risk category should undergo active monitoring, including restriction from work in any healthcare setting until 14 days after their last exposure. HCP in the low-risk category should perform self- monitoring with delegated supervision until 14 days after the last potential exposure. HCP in the no identifiable risk category do not require monitoring or restriction from work.
Resources CDC checklist for readiness: https://www.cdc.gov/coronavirus/2019- ncov/downloads/novel-coronavirus-2019-Nursing-Homes-Preparedness- Checklist_3_13.pdf. (with links) AMDA Resident screening form https://paltc.org/sites/default/files/Active%20Screeningv1_03.16.20.pdf Facility Exposure Management https://paltc.org/sites/default/files/COVID- 19%20Facility%20Exposure%20Management- %20COVID19%20PositiveV3.pdf. ICAP Stop sign https://icap.nebraskamed.com/wp- content/uploads/sites/2/2020/03/STOP-Help-Protect-Our- Residents3.16.20.pdf ICAP Visitor questions https://icap.nebraskamed.com/wp- content/uploads/sites/2/2020/03/Visitor-Screening-for-LTCF-3.16.2020.pdf ICAP Log https://icap.nebraskamed.com/wp- content/uploads/sites/2/2020/03/visitor-screening-LOG-3.16.2020.xlsx link for COCA Call from 3.17.2020 https://emergency.cdc.gov/coca/calls/2020/callinfo_031720.asp?deliveryNa me=USCDC_1052%20DM22856 . Strategies for optimizing PPE https://www.cdc.gov/coronavirus/2019- ncov/hcp/ppe-strategy/index.html
Implement Crisis Capacity Strategy- facemasks • Cancel all elective and non-urgent procedures and appointments for which a facemask is typically used by HCP. • Use facemasks beyond the manufacturer-designated shelf life during patient care activities. • Implement limited re-use of facemasks. • Prioritize facemasks for selected activities https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe- strategy/face-masks.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
Prioritization of activities For facemasks • For provision of essential surgeries and procedures • During care activities where splashes and sprays are anticipated • During activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable • For performing aerosol generating procedures, if respirators are no longer available https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe- strategy/face-masks.html
Infection Prevention and Control Office Hours Monday – Friday 7:30 AM – 9:30 AM Central Time 2:00 PM -4:00 PM Central Time Call 402-552-2881
Weekly COVID-19 LTC Webinars DHHS in association with ICAP will continue to host weekly webinars specific to LTCF in the state of Nebraska. The webinars will continue to address situation updates and essential information on COVID-19. Link to weekly COVID-19 LTC webinar invite https://icap.nebraskamed.com/covid-19-webinar-invite-ltcf/ Link to past webinars and recordings https://icap.nebraskamed.com/covid-19-webinars/
Questions and Answer Session Use the QA box in the webinar platform to type a question. Questions will be read aloud by the moderator, in the order they are received A transcript of the discussion will be made available on the ICAP website Panelists today are: Dr. Salman Ashraf, MBBS Dr. Maureen Tierney, MD,MSc Ishrat Kamal-Ahmed, M.Sc., Ph.D Kate Tyner, RN, BSN, CIC https://icap.nebraskamed.com/covid-19-webinars-and-tools Margaret Drake, MT(ASCP),CIC Teri Fitzgerald RN, BSN, CIC
Recommend
More recommend
