1 Steps to Take Now to Prepare for COVID-19 Stay informed about - - PDF document

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Coronavirus COVID‐19 ‐ Infection Prevention & Control: Getting to the Root Cause

Pamela Truscott, MSN, RN, DNS-CT, QCP, RAC-CT Senior Manager, Clinical and Regulatory Services COVID-19 Questions email - COVID19@ahca.org

Background COVID-19

• Coronavirus Disease 2019 (abbreviated COVID-19) is caused by a

new coronavirus that has not previously been identified

• First detected in China and has now been detected in 60

locations internationally, including the United States

• Within the U.S. cases have been detected in 13 states, including

a SNF in WA

• Spread: mainly person-to-person through respiratory droplets

between people in close contact (within six feet)

• Symptoms are
• Fever, cough, sore throat, aches (much like influenza), and

shortness of breath

Background COVID-19

• Risk for severe illness is greatest in
• Elderly
• Chronic diseases
• Immunocompromised (i.e. chronic steroids & chemotherapy)
• Treatment
• Clinical management includes prompt implementation of

recommended infection prevention and control measures and supportive care

• NO vaccine or antiviral medication yet

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Steps to Take Now to Prepare for COVID-19

• Stay informed about COVID-19 by monitoring
• CDC COVID-19 website
• https://www.cdc.gov/coronavirus/2019-ncov/index.html
• Your state/local health department
• Communicate with residents, family, staff, suppliers and hospitals (more on

upcoming slide)

• Monitor residents and healthcare personnel (HCP) for fever or

respiratory symptoms

Steps to Take Now to Prepare for COVID-19

• Support hand and respiratory hygiene, as well as cough etiquette by residents,

visitors, and HCP

• Ensure HCP clean their hands before and after contact with residents, after

contact with contaminated surfaces or equipment, and after removing personal protective equipment (PPE)

• Clean hands with alcohol based hand rub or with soap and water
• Ensure access to alcohol based hand rub (ideally both inside and outside of the

room)

• Restrict visitors and staff with respiratory illnesses
• Ensure you have access to recommended PPE
• Review your facility’s emergency plan

Communicate with:

• Residents
• Visitation restrictions on people with symptoms of respiratory infection
• Ok to remind staff to clean their hands
• Steps you are taking to prevent spread
• Families
• Not to visit if respiratory illness symptoms or fever
• Facility is following CDC guidance on prevention steps to take and in contact

with local/state health department

• Note: Keep in regular communication and update concerned residents and families

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Communicate with:

• Staff
• In general, care of residents with undiagnosed respiratory

infection use Standard, Contact, and Droplet Precautions with eye protection unless suspected diagnosis requires Airborne Precautions (e.g., tuberculosis);

• If COVID-19 is suspected use Standard, Contact, and Droplet

Precautions with eye protection

• Don’t report to work if symptoms of respiratory illness

Communicate with:

• Local Hospital
• Communicate at time of transfer if residents with fever or respiratory illness or

confirmed or suspected COVID-19 and need hospital care

• Local/State Health Department
• Report any possible COVID-19 illness in residents or HCP to local/state health

department, including your state HAI/AR coordinator

• Assess supplies and report possible or expected shortages to local/state

health department and local/state healthcare coalition (https://www.phe.gov/Preparedness/planning/hpp/Pages/find-hc- coalition.aspx)

Screening for New Admissions

• Admissions should be screened for risk factors and symptoms of

respiratory infection BUT testing of asymptomatic residents is not recommended

• Fever, cough, sore throat, aches, shortness of breath, history
• f exposure
• Notify health department if concern for possible COVID-19
• Place individual in single room and in Standard, Contact and

Droplet Precautions with eye protection until further direction from health department

• If do not have fit-tested HCP or N-95 or higher-level respirators

then you should limit contact with the resident and use Standard, Contact, and Droplet Precautions with eye protection if contact must occur while arranging for transfer

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Screening for New Admissions

• Should we stop admissions if COVID-19 is found in our facility?
• This decision needs to be guided by your local health

department.

Who should be tested for COVID-19?

• Referral for testing symptomatic patients
• Follow CDC guidance, contact local health department for testing guidance

for those with symptoms

• Guidance for Evaluating and Reporting Persons Under Investigation:
• https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

Visitors – what is best practice?

• CDC has provided guidance on visitors as well as people who have

traveled to/from restricted countries

• Guidance on visitors (see recommendation #3):
• https://www.cdc.gov/coronavirus/2019-ncov/infection-

control/control-recommendations.html

• Travel & restricted countries:
• https://www.cdc.gov/coronavirus/2019-

ncov/travelers/index.html

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Visitors – what is best practice?

• Decisions on restricting all visitors should be made based on the

situation in your facility and community. This should be informed by updates provided by your local health department about COVID-19 in the community.

• Note: If the decision is made by your local health department to

restrict visitors, it is essential to clearly communicate this with residents and families. Encourage them to stay in contact through alternative means such as Skype, or telephone.

Staff – what is best practice?

• Restrict workers (HCP) who have fever or symptoms of respiratory

infection

• Follow CDC guidance sick employees staying home
• https://www.cdc.gov/coronavirus/2019-ncov/specific-

groups/guidance-business-response.html

• Ensure sick leave policies allow HCP to stay home when ill
• Staff who become sick while at work (i.e., fever, cough, or sore throat)

should immediately self isolate, put on a facemask and go home

• Decisions about when ill HCP may return to work should be made in

consultation with the facility's infection preventionist; CDC is developing guidance on criteria that can be used to inform this decision

• If exposed to COVID-19, follow the local health

department recommendations

Supply Demands

• Accessing and ordering supplies
• Many routine supplies are manufactured in China or
• ther countries with COVID-19 outbreaks affecting supplies
• Some suppliers have long back orders
• Assess your supplies
• Contact your local/state health department and

local/state healthcare coalition if supplies are running low (https://www.phe.gov/Preparedness/planning/hpp/ Pages/find-hc-coalition.aspx)

• US government working to increase production and distribution
• Optimize and prioritize use of existing supplies

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• Routine cleaning and disinfection procedures are appropriate for SARS-CoV-

21 in healthcare settings, including those patient-care areas in which aerosol- generating procedures are performed.

• EPA-registered hospital-grade disinfectants with an emerging viral pathogens

claims are recommended for use against SARS-CoV-2.

• If there are no available EPA-registered products that have an

approved emerging viral pathogen claim for COVID-19, products with label claims against human coronaviruses should be used according to label instructions.

Environmental Cleaning and Disinfection

• Management of laundry, food service utensils, and medical waste should also

be performed in accordance with routine procedures.

• CDC has created FAQs about PPE that should be worn by EVS personnel and

recommendations for terminal cleaning: https://www.cdc.gov/coronavirus/2019- ncov/infection-control/infection-prevention-control-faq.html

• Note: Follow manufacturer instructions to ensure effectiveness of cleaning and

disinfection agents.

Suspected COVID-19 Cases – What to do

• If you suspect a resident has COVID-19, you should

contact the health department. The resident should be transferred if:

• They require a higher-level of care OR
• You are not capable of implementing Contact

and Airborne Precautions with eye protection

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Review your Cohorting Policies

• Cohorting residents
• The health department should help inform

decisions about cohorting residents

• If you have multiple cases implement your

infection control program for outbreaks including moving and cohorting ill residents.

• What to do with roommates of person who tests positive?
• Asymptomatic roommates are likely already exposed,

so either move to single room or stay in place as moving in with another resident may increase spread in the facility.

What can you do to reduce the spread

• f infection?
• Foster – foster teamwork and support of each other across all teams
• Identify – Identify areas of workflow improvement to give staff more

time to focus on doing the right thing consistently

• Help – Help staff understand the implications/impact of their actions
• n residents/patients when protocols are followed or not
• Capture – Capture all opportunities to recognize proper and

improper practices, using just in time teaching and recognition moments

• Don’t Underestimate – Don’t underestimate the importance of basic

practices such as hand hygiene, peri-care, wound care, equipment cleaning and storage, etc.

What can you do to reduce the spread of infection?

Encourage

Encourage peer to peer accountability, spreading constructive feedback focused on strengths building

Empower

Empower residents, family and staff to speak up when protocols are not being followed

Share

Share real stories from care provided in your center – both success and failure stories bring focus to the impact

• n the

resident/patient

Perform

Perform routine

• bservations

throughout the center, both structured and unstructured to keep an “eye” out for signs of slipping practices

Consider

Consider registering for the AHCA Infection Preventionist Specialized Training (IPCO) to drive effective systems‐ based approaches to infection prevention & control across the center

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Operationalizing an Infection Control Plan

Policies and procedures to identify and assess high‐risk residents Educate and competency check to ensure staff compliance with standard precautions, enhanced barrier precauons , contact precauons, and droplet precauons Evaluate environmental cleaning and disinfection for compliance and effecveness Communication plan with residents, families, staff, referral sources, hospitals, physicians, community, etc. For confirmed cases, place resident in a private room, if possible, and utilization of droplet precauons should be followed

Coronavirus – COVID-19

• Coronaviruses are typically found in animals (camels, cattle, cats, bats) – rarely

animal coronaviruses can infect people and then spread (MERS, SARS and now COVID-19)

• Spread through person-to-person contact (droplets produced by infected person

through coughing/sneezing) similar to other influenza and respiratory pathogens

• Symptoms include: fever, cough, shortness of breath
• Prevention: currently no vaccine to prevent – hand hygiene, avoid touching face,

avoid contact with sick people, stay home when you are sick, cover mouth/nose when cough/sneeze then dispose, clean and disinfect frequently touched

• bjects/surfaces

CDC Implementation Recommendations

• “Critical to ensure staff have awareness of facility’s expectations about hand hygiene

and gown/glove use, initial and refresher training, and access to appropriate supplies”

• Post clear signage on door/wall outside resident rooms

indicating Precautions/required PPE

• Make PPE immediately available
• Ensure access to alcohol-based hand rub
• Position trash cans for easy disposal after use
• Incorporate periodic monitoring/assessment of adherence
• Provide education to residents/visitors

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Facility Responsibility & Reliable Solutions

• Review and update policies and procedures
• Educate and train staff
• Include education on policy and procedure updates
• Spread of infection
• Competency evaluations routine and unannounced
• Appropriate environmental cleaning and appropriate disinfection
• Know when to implement Standard, Enhanced Barrier Precautions, Contact,

Droplet precautions

• Contact local health department for more information
• EBP FAQs - https://www.cdc.gov/hai/containment/faqs.html

Facility Responsibility and Regulatory Impact

• With any outbreak – the public eye turns to what you are

doing

• It is critical to have an effective infection control program

in place

• Have a trained infection preventionist on staff
• Use tracking data to inform areas where improvement is

needed

• Utilize your QAPI process to continuously make

improvements

• Education of your staff extremely important

Facility Resources and Tools

• Use CMS Critical Element

Pathways

• https://www.cms.gov/Medicare/

Provider-Enrollment-and- Certification/GuidanceforLaws AndRegulations/Downloads/LT C-Survey-Pathways.zip

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Facility Resources and Tools

• Use CDC Infection Control Assessment

Response Program (ICAR) Tool

• https://www.cdc.gov/infectioncontrol/pdf/icar/ltc

f.pdf

Resources

• CDC website
• https://www.cdc.gov/coronavirus/2019-ncov/index.html
• AHCA/NCAL website
• https://www.ahcancal.org/facility_operations/disaster_planning/Pages/Coronavirus.as

px

• ahcancalED COVID-19 Course (open to everyone)
• http://educate.ahcancal.org/p/COVID19

Resources

• CDC COVID-19 IPC Guidance for Healthcare Settings
• https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-

recommendations.html

• Resources for LTCF
• https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html
• Strategies to Prevent COVID-19 Spread in LTCF
• https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-

spread-in-long-term-care-facilities.html

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CDC SpecResourcesific Resources #2

• How COVID-19 Spreads
• https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html
• COVID-19 Symptoms
• https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html
• Prevention & Treatment
• https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html
• COVID-19 Testing
• https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html
• COVID-19 FAQs
• https://www.cdc.gov/coronavirus/2019-ncov/faq.html

CDC SpecResourcesific Resources #3

• CDC’s Crisis and Emergency Risk Communication (CERC)
• https://emergency.cdc.gov/cerc/manual/index.asp
• https://emergency.cdc.gov/cerc/resources/pdf/CERC_Infectious_Disea

ses_FactSheet.pdf

AHCA/NCAL Coronavirus Website Portal

http://www.ahcancal.org/coronavirus

COVID-19 Questions email - COVID19@ahca.org

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