COVID-19 and LTCSeptember 24, 2020

Guidance and responses were provided based on information known on 9/24/2020 and may become out of date. Guidance is being updated rapidly, so users should look to

CDC and NE DHHS guidance for updates.

Questions and Answer SessionUse the QA box in the webinar platform to type a question. Questions will be read aloud by the moderatorIf your question is not answered during the webinar, please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs

A transcript of the discussion will be made available on the ICAP website

Panelists today are:

Dr. Salman Ashraf, MBBS salman.ashraf@unmc.eduKate Tyner, RN, BSN, CIC ltyner@nebraskamed.comTeri Fitzgerald, RN, BSN, CIC TFitzgerald@nebraskamed.comSarah Stream, MPH, CDA sstream@nebraskamed.comJody Scebold, Ed, MSH, RN jodscebold@nebraskamed.com

https://icap.nebraskamed.com/coronavirus/https://icap.nebraskamed.com/covid-19-webinars/

Infection Prevention and ControlOffice Hours

Monday – Friday 8:00 AM – 10:00 AM Central Time

2:00 PM -4:00 PM Central TimeCall 402-552-2881

COVID-19 Nursing Home Visitation

COVID-19 Nursing Home Visitation

• CMS updated guidance on visitation within nursing homes (QSO-20-39-NH) on September 17, 2020

• The new guidance summary can be found at: https://www.cms.gov/files/document/qso-20-39-nh.pdf

• This guidance is to help nursing homes protect their staff and residents when developing a plan for allowing outside visitors to enter the facility

• Visitation has been recognized to provide a positive impact on residents from physical, emotional and spiritual support they may receive

• Facilities should make these visitation decisions based on their own county and facility circumstances and on an individual basis

COVID-19 Nursing Home Visitation

• Determining indoor visitation based on County Positivity Rates

• Refer to County Positivity Rate (%)

• Low (<5%): Visitation can happen according to the core COVID-19 Infection Prevention Policies

• Medium (5-10%): Visitation can happen according to the core COVID-19 Infection Prevention Policies

• High (>10%): Visitation should only occur for compassionate care situations according to the core COVID-19 Infection Prevention Policies

•Testing prior to visit is encouraged for visitors in counties with high community spread

COVID-19 Nursing Home Visitation

• Core Principles of COVID-19 Prevention for visitors

• Screening of all visitors for fever and symptoms

• Hand hygiene

• Source Control (mask or face covering)

• Social distancing (at least 6 feet)

• Visitor education signage (use of face coverings, entries, exits, hand hygiene)

• Frequent cleaning and disinfection of high traffic areas

• Staff use of appropriate PPE

• Effective resident cohorting

• Resident and staff testing

COVID-19 Nursing Home Visitation

• Outdoor Visitation

• Preferred visitation method

• Reduces risk of COVID-19 transmission

• Increased space and airflow

• Infection prevention protocols should still be followed (hand hygiene, face coverings, social distancing)

• Safe, accessible space should be crated for visitation

• Number of visits and size of visitor group should be limited to promote safe visits (social distancing)

•Courtyards, patios, parking lots and tents can be used to create an outdoor visitation space

COVID-19 Nursing Home Visitation

• Indoor Visitation Guidelines

• No new onset COVID-19 cases in the last 14 days

• Facility is not actively conducting outbreak testing

• Visitors should adhere to core infection prevention policies

• Staff should provide monitoring during visitation for those that can’t adhere to infection prevention policies (e.g. children)

• Limit number of visitors per resident according to space

• Limit movement throughout the building if indoor visitation is occurring (designated areas)

• If residents share rooms, visits should not be conducted in the resident room unless the health status of the resident prevents them from leaving the room

COVID-19 Nursing Home Visitation

• Compassionate Care Visits can include

• End of Life

• Struggle with change of environment (moving from a family home into a facility)

• Grieving resident

• Needs encouragement for eating and drinking that was previously done by friends or family members

• Resident that is showing emotional distress from change in social environment

•Compassionate care visits can be made by family or any other individual that meets the residents needs (clergy, volunteers, etc.)

COVID-19 Nursing Home Visitation

• Required Visitation

• Visitation may be restricted on the basis of County Positivity Rate, Facility COVID-19 status, Resident COVID-19 status and visitor symptoms

• Facilities should prioritize the health of their residents, staff and visitors

• Facilities may not restrict visitation without a reasonable clinical or safety cause

• Residents in Red or Yellow zones should have visits virtually or through windows, if an in person visit is needed for compassionate care, visitors should adhere to all transmission based precautions during their visits

Positive Case Volume

Positive Case Volume

% Positive by Specimen Collection Date

Positive Case Volume

% Positive by Specimen Collection Date

New Positive Cases by Date of Results

Auditing and Feedback

Auditing and Feedback• Auditing and Feedback are a Quality Improvement

strategy to help facilities recognize and address potential issues

• Auditing is used to observe healthcare processes and compare them to the required standards

• Feedback is then given back to employees to help them understand the standards and what changes, if any, need to be made to stay compliant

• Staff training needs can be identified using the auditing process

Recent Audit Findings The following have been reported by licensure and NETEC during site visits and are things that SHOULD NOT be done

• Hand Hygiene

• Using soap and water over alcohol based hand sanitizer

• Restricted access to alcohol based hand sanitizer

• General Housekeeping

• Reusing supplies in more than one room: Sponge

• PPE

• Doffing in the hallway or a “clean zone”

• Walking in hallway in soiled PPE

• Lack of waste bins at point of PPE use: Carrying soiled PPE to disposal area

• Reuse of PPE from room to room: Gowns and housekeeping

• Eye Protection

• Lack of supplies: More than one person sharing a face shield

• Inappropriate eye protection use: uncomfortable

• Sitting eyewear or face shield on a soiled surface/ linen

Staff Breaks

Best Practices for Staff Breaks• Staff should be practicing source control and social

distancing protocol during breaks

• Maintain 6-10 foot distance from others while eating

• Stagger staff breaks to comply with social distancing in the space you have available

• Have staff take breaks in larger areas, such as dining rooms (when no residents are present) or larger conference rooms

• Use barriers to provide protection for staff that is eating

Best Practices for Staff Breaks

Example of barriers in a dining room that has been used as a staff break area

Nursing Home Project ECHO Update

Nursing Home Project ECHO

• 144 NE Facilities have registered so far and 18 Out of State Facilities

• There is still time to register, but time is running out!!

• Facilities will be assigned to a Cohort group of 33-34 other facilities to create a learning and networking environment

• A survey has been sent to you about your facility participants, please fill this out ASAP

• Please do not duplicate this participant survey, you will have the chance to adjust team members when the program launches

Nursing Home Project ECHO

• 90 minutes per week of educational content in group settings through Zoom

• 16 weeks of mandatory course (with certificate of completion)

• 32 weeks of 60 minute sessions optional after that

• 3 to 4 healthcare workers will participate in this training (e.g. medical director, nurses/ Ips, QI Staff, or other staff interested in getting involved in quality improvement process)

• LTCF will receive some funding to compensate for the staff time spent on training

Nursing Home Project ECHOPoll: We are collecting information on times for scheduling of cohorts, please answer the following question if you have registered for the Nursing Home Project ECHO.

What time of the day that you think you can have all your team members (MD, Nurse, Admin and other staff) together to attend the ECHO session?

• 7:00 am -- 8:30 am

• 11:30 am – 1:00 pm

• 12:00 pm – 1:30 pm

• 4:00 pm – 5:30 pm

• 4:30 pm – 6:00 pm

We are on Facebook!

• This platform will be used to distribute Infection Prevention and Control Training to Firstline Staff

• The staff will be able to receive training certificates for participating in the training programs

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:Dr. Salman Ashraf, MBBSKate Tyner, RN, BSN, CICTeri Fitzgerald, RN, BSN, CICSarah Stream, MPH, CDAJody Scebold, Ed, MSN, RN

Moderated by Mounica Soma, MHA

Supported by Marissa Chaney and Margaret Deacy

https://icap.nebraskamed.com/resources/

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