COVID-19 and LTCMay 7, 2020

Guidance and responses were provided based on information known on 5/7/2020 and may become out of date.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 IPsA 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.comMargaret Drake, MT(ASCP),CIC Margaret.Drake@Nebraska.govTeri Fitzgerald RN, BSN, CIC tfitzgerald@nebraskamed.comAngie Vasa RN, BSN avasa@nebraskamed.comDoug Carlson doug.Carlson@Nebraska.govDr. Tom Safranek tom.safranek@Nebraska.gov

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

https://nebraska.maps.arcgis.com/apps/opsdashboard/index.html#/4213f719a45647bc873ffb58783ffef3

Coronavirus COVID-19 Nebraska Cases

New positive cases by date results were received

Nebraska Case Update

Cases in Long-Term Care

Data as of 5/6/2020

Facility Type Total Count in NE

Number of Facilities with Positive Residents

PercentFacilities with Positive Residents

Number of Residents Positive Deaths

Death percent*

Skilled Nursing Facilities/Nursing Facilities (SNF/NF) 211 18 8.5% 167 43 51.2%

Assisted Living Facilities (ALF) 286 9 3.1% 83 13 15.5%

Total 497 27 11.7% 250 56 66.7%

* Total deaths in state as of 5/6/2020 = 84

What is an exhalation valve?• The presence of an exhalation valve reduces

exhalation resistance, which makes it easier to breathe (exhale). Some users feel that a respirator with an exhalation valve keeps the face cooler and reduces moisture build up inside the facepiece.

• exhalation valve allows unfiltered exhaled air to escape into the environment

• An N95 respirator with an exhalation valve does provide the same level of protection to the weareras one that does not have a valve.

.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

Dining and Outings. Q: Communal Dining: Are all residents forced to eat in their room?

A: Residents are not forced to eat in their rooms. Residents may still eat in dining rooms, however, nursing homes should adhere to social distancing, such as being seated at separate tables at least six feet apart. We note that social distancing should be practiced at all times (not just while dining). We further note that eating in dining areas with appropriate social distancing only applies to residents without signs or symptoms of a respiratory infection, and without a confirmed diagnosis of COVID-19. Facilities should refer to CDC guidelines for managing residents with signs or symptoms of a respiratory illness.CMS

Additional Measures:

Cancel communal dining and all group activities, such as internal and external activities.

Remind residents to practice social distancing and perform frequent hand hygiene.

Have residents wear a cloth face covering or facemask whenever they leave their room, including for procedures outside of the facility.

CDC

Staff training

Personal Protective Equipment (PPE) shortages pose a specific challenge when training staff to don and doff PPE appropriately. In times of shortage, we are either extending use, or, if in a crisis situation, trying to follow reuse guidance.

It is especially important, in this period of shortage that long-term care facilities are currently experiencing, to ensure staff are trained on donning and doffing PPE safely, with contamination risks in mind.

Staff training When considering where to start with staff training needs, you will be best served if you start observing staff in their work environment.

Go out with a specific practice or practices to observe – hand hygiene, PPE donning and doffing, mask use, gown use, and environmental cleaning….note competency of staff in their performance of these practices

Once you have identified areas of concern, you may wish to engage some of your staff to become super users, and enlist their help in helping others. They may need some initial training on proper steps of procedure, how best to observe, and how to approach staff to help them correct any inappropriate practices.

Staff training – hand hygieneFirst, let’s discuss hand hygiene, as HH is a basic infection control practice that ensures we have clean hands before donning PPE, and during doffing of PPE. Staff should know how to perform correctly in each situation.

• What is the facility expectation for performance of hand hygiene? Perform in sinks only? Or is ABHR available?

• Do you have ABHR available throughout your facility?

• Do you routinely observe HH performance and give feedback to staff?

Staff training – PPEMasks • Have you trained staff on the appropriate way to

don and doff a mask, with contamination risks in mind?

• Do staff understand keeping mask on and risks with wearing it improperly?

• What are the expectations currently with mask use – extended wear vs. reuse?

• Do staff know how to store masks for reuse?• Are you currently observing staff donning and

doffing of masks and giving feedback?

Staff training – PPEGowns• Have you trained staff on the appropriate way to

don and doff a gown, with contamination risks in mind? (for both cloth and disposable)

• Do staff know where to doff their used gown?• Are there waste containers for gloves and

disposable gowns and laundry containers for sloth gowns near exit in resident rooms?

• What are the expectations currently with gown use – extended wear vs. reuse?

• Are you currently observing staff donning and doffing gowns and giving feedback?

Staff training - PPE

https://repository.netecweb.org/files/original/b1abd8f26ee3739f72e62718691f663b.pdf

Staff training – environmental cleaning

Here are the links to the Environmental Cleaning Videos. These are available in 4 languages. https://icap.nebraskamed.com/practice-tools/educational-and-training-videos/draft-environmental-cleaning-in-healthcare

https://www.cdc.gov/hai/pdfs/toolkits/environmental-cleaning-checklist-10-6-2010.pdf

Staff training: Barriers & IdeasBarrier Idea

Not enough time Designate a “training extender” per shift

No team members feel comfortable giving feedback

• Utilize checklists• Round in teams• Script feedback “I care about you and

want you to be safe.”

Team members don’t handle criticismwell

• Phrase feedback in a way that doesn’t feel like criticism

• Offer feedback when good practice is observed

Care happens behind a closed door • Use 2-person tasks for audit and feedback

• Shadow staff and use time to check in with residents

Anticipate findings• A protocol has been updated and this teammate on night

shift wasn’t notified - Is our communication process working for all shifts?

• Ask for staff input “I see that this is difficult for you. How can we work together to make the process easier to follow?”

• Let them know your thoughts as well – “When we designed or implemented the workflow, we didn’t think of this barrier. Let’s take it back to the team to think through the best way to deal with this issue.”

Doug CarlsonDeputy Director, Nebraska Department of Administrative Services

Chief Procurement Officer for the state of Nebraska

Materiel Division Administrator

Acting State Building Division Administrator

OFFICE 402-471-6500

CELL: 531-207-3309

doug.carlson@nebraska.gov

ResourcesCDC HCP return to work criteria Updated 4/30/2020 https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.htmlStrategies for optimizing PPE https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.htmlUniversal Mask Policy and FAQ, Nebraska Medicinehttps://www.nebraskamed.com/sites/default/files/documents/covid-19/surgical-mask-policy-and-faq-nebraska-med.pdfProper Donning & Doffing of Procedural and Surgical Masks- Nebraska Medicine (Video) https://www.youtube.com/watch?v=z-5RYKLYvawCOVID-19: Conserving PPE Emory University School of Medicine (posters and videos)https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/conserving-ppe.htmlNETEC PPE Competency Validation checklist https://repository.netecweb.org/files/original/b1abd8f26ee3739f72e62718691f663b.pdfNE ICAP EVS Videos https://icap.nebraskamed.com/practice-tools/educational-and-training-videos/draft-environmental-cleaning-in-healthcareCDC EVS cleaning checklist https://www.cdc.gov/hai/pdfs/toolkits/environmental-cleaning-checklist-10-6-2010.pdfNC SPICE program hand hygiene competency checklist https://spice.unc.edu/wp-content/uploads/2017/03/Hand-Hygiene-Competency-SPICE.pdf.

Weekly COVID-19 LTC WebinarsDHHS 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/

Infection Prevention and ControlOffice Hours

Monday – Friday 7:30 AM – 9:30 AM Central Time2:00 PM -4:00 PM Central Time

Call 402-552-2881