Please find our weekly update and feel free to share and pass along to your colleagues. Please do not hesitate to contact IPCWell for any questions or support.
CMS IPC Requirements and Executive Orders:
- Update your emergency preparedness plan with COVID-19 information. You can utilize the CMS COVID-19 focused infection control survey to assist you.
- Review all COVID-19 infection control requirements to ensure that you are appropriately implementing ALLinfection control practices (nursing homes and acute and continuing care).
- States continue to receive updated Executive Orders for combatting COVID-19. You can check your EO here.
Screening/Testing:
- Antibody testing to determine if an individual is immune from COVID-19 (not a diagnostic tool) is being advertised from several laboratories. Currently the CDC does not have information regarding this testing, therefore, continue utilizing FDA approved diagnostic tests for COVID-19.
- The CDC has implemented a “Self-Checker” to help individuals make decisions to seek the appropriate level of care.
- (Update April 7, 2020) Phone Advice Line Tool for screening patients for COVID-19.
- (Updated April 12, 2020) Interim Guidance for Implementing Home Care of people Not requiring Hospitalization.
PPE Hierarchy
- According to the CDC, an N-95 mask is preferred, however, they state that a surgical mask is an acceptable alternative.
- Many facilities now have access to N-95 masks, however, have had a challenge with getting the appropriate OSHA required “fit-test”.
- If your facility is in need of this requirement, you can reach out to Karin Pena, and she can coordinate a representative to come to your facility to perform (parking lot party) this requirement.
- IPCWell has been participating in the American College of Medical Toxicology webinars this week and Dr. Joseph Cocciardi describe in detail the difference between an N-95 mask and surgical mask. He also provided IPCWell with the following hierarchy for protecting against COVID-19. Please note having a N-95 mask without a fit test provides a higher level of protection than a surgical mask along.
- Engineering Controls like a Fan/Neg pressure room, shield etc.
- Good Respirator (N-95)
- Respirators from other countries with FT
- Expired N-95 respirator with FT
- Respirator without a fit test.
- Respirators from other countries without a FT, then the expired ones.
- Surgical masks
- Home Made devices (scarves).
- Back to Engineering Controls like a Fan/Neg Pressure room, shield etc.
Positive COVID-19 Patients/Residents: Public Health strongly recommends that long-term care facilities and nursing facilities accept their residents back from hospitals after they no longer require acute care. Hospitals are encouraged not to keep patients for isolation because the county will run out of inpatient bed capacity if patients cannot be discharged.
- Consider placing all new admission and readmissions on a 14-day isolation once admitted to the facility (some states such as Arizona this is an Executive Order). This does not mean transmission-based precautions need to be applied (droplet/contact) unless suspected or COVID-19 positive.
- Consider having residents/patients where a mask when a healthcare provider enters the room.
- Please keep all patients/residents with COVID-19 isolated until 7 days after their last positive test AND until they have not had fever or symptoms for 72 hours (without the use of fever-reducing medications).
- DO NOT require that patients/residents have a negative COVID-19 test before accepting them back into your facility.
- Encourage residents to remain in their room and restrict movement except for medically necessary purposes.
- If residents leave their room, residents should wear a facemask, perform hand hygiene, limit their movement in the facility, and perform social distancing (stay at least 6 feet away from others).
- If possible, designate a ward or section of the facility for COVID-19 patients with dedicated staff.
- Implement protocols for having dedicated healthcare personnel caring for cohorted residents with COVID-19.
Positive or Suspected COVID-19 Employees:
- If employees develop any symptoms consistent with COVID-19 (fever or respiratory symptoms) they must:
- Cease contact with residents/patients.
- Put on a facemask immediately (if not already wearing).
- Notify their supervisor or occupational health services prior to leaving work.
- Allow asymptomatic employees to continue to work after consultation with their occupational health program.
- Use your monitoring system to ensure exposed employees are monitored daily for the 14 days after the last exposure.
- If the healthcare facility has a sufficient supply, healthcare personnel who were not wearing recommended PPE during the COVID-19 exposure could be asked to wear a facemask while at work for the 14 days after the exposure.
Prevent the spread of respiratory germs BETWEEN facilities:
- Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
- Report any possible COVID-19 illness in residents and employees to the local health department.
- HCP who work in multiple locations may pose higher risk and should be asked about exposure to facilities with recognized COVID-19 cases.
- Consider encouraging staff to work at only one facility.
- When transmission in the community is identified, nursing homes and assisted living facilities may face staffing shortages. Facilities should develop (or review existing) plans to mitigate staffing shortages.
PPE Requests:
There is an extremely limited Personal Protective Equipment (PPE) available for order. It is very important that you realize that submission of a resource request does not guarantee your order will be filled. Orders will be prioritized based on critical healthcare and current supplies. Before submitting a PPE request you must prove that you have taken the following steps:
- Followed CDC’s guidance on optimizing PPE Supplies
- Reached out to multiple vendors. If vendors cannot supply your order, keep the documentation.
- Reached out to other partners in the area. Many jurisdictions are already sharing with each other.
- Reached out to partners outside of the area. Partners in other states might have extra supplies to help bridge gaps in back orders.
- If you have completed these steps, contact your local or state public health department.
Environmental Cleaning:
- Make sure that EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident care equipment.
- Refer to the EPA list for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.