Guidelines to prevent and control the spread of COVID-19

The general strategies that CDC recommends to prevent the spread of COVID-19 in healthcare facilities are the same strategies to detect and prevent the spread of other respiratory viruses like influenza. If there is a concern that a resident, visitor, or employee may be a COVID-2019 resident under investigation or is diagnosed with COVID 19, the facility should contact their local or state health department immediately for consultation and guidance. Following the guidelines below will ensure protection of personnel and prevention of the spread of the infection.

Updated: 4/14/20

 

Center Visitation

  1. Restriction of non-essential visitation and movement within the facility except for certain compassionate care situations, such as end of life situations is enforced.
  2. In lieu of visitation, community shall be offering alternative means of communication for people who would otherwise visit, such as virtual communications (phone, videocommunication, etc.).
  3. Notification via letters and/or emails to families was sent advising them that no visitors will be allowed in the facility except for certain compassionate care situations, such as end of life
    situations.
  4. For individuals that enter in compassionate situations (e.g., end-of-life care), center should require visitors to perform hand hygiene and use Personal Protective Equipment (PPE),
    such as facemasks. They should also be reminded to frequently perform hand hygiene.Visitor will be required to:
  • Have the visitor surveillance completed. The temperature will be taken and if it is above 99.6 degrees F or higher visiting will be prohibited
  • Wash hands before and after visit
  • Must wear a mask during their visit
  • Limit movement in the center, limit the time spent at the center and stay at the designated area only
  • Supply Vendors (including USPS) are to drop supplies outside the center, they are not to enter the center without written permission from the administrator. Arrangements will be
    made with the delivery of medications from pharmacy limiting entry to the center.
  • Visitation will be only to essential personnel such as emergency personnel, diagnostic related personnel such as laboratory, mobile X-ray, medical professionals (Physicians, NPs, PAs) and Government/State agency personnel.
  • All group activities including communal dining are cancelled. (Note: this does NOT apply to residents who need to leave the building for medical care such as dialysis, medical visits, etc.). Resident activities will be provided in resident rooms.

 

Communication and Updates

  1. Appropriate notification in regards to a COVID-19 positive resident and/or facility staff member is to be completed within 24 hours to all facility residents, staff members, and permissible visitors.
  2. The center administrator/designee shall provide notification to its staff of the presence of a COVID-19 positive resident or staff member in the facility in accordance with the April 4 2020 NJ DOH Directive.
    1. Employees will be notified daily in writing via hard copy after the screening upon entrance. There will be a check off via the PCPAYROLL roster to ensure compliance.
    2. Employee communication will occur during shift change, before the start of shift and any updates will be provided at the end of the shift. This will include updates related to residents as well as employees appropriately.
  3. The center administrator/designee shall provide notification to residents (as appropriate) of the presence of a COVID-19 positive resident or staff member in the facility in accordance with the April 4 2020 NJ DOH Directive.
    1. Daily communication by social worker/designee will be ensured for all residents and the resident will be notified via hard copy also as appropriate. Social workers/designee will answer any questions or concerns the residents might have and will provide emotional support. To ensure compliance a log will be maintained as supporting documentation.
    2. When a resident is noted as COVID positive, the nurse will notify physician, leadership and appropriate authorities including local department of health. Information will be relayed to the resident and/or significant other as appropriate. This information will be documented under appropriate communication in electronic medical record.
  4. The center administrator/designee shall provide notification to family/significant others, visitors or vendors of the presence of a COVID-19 positive resident or staff member in the facility in accordance with the April 4 2020 NJ DOH Directive.
    1. Center will notify the families/significant other in writing via email and ensure a compliance a log will be maintained and the email will be printed
      as supporting documentation.
    2. The center will ensure proper notification of families / significant others when a resident is positive or when a resident is presumptive positive and in regards to any clinical updates. This information will be documented in the clinical record.
    3. Center will notify all vendors via email in regards to the update. To ensure compliance a log will be maintained and the email will be printed as supporting documentation.
    4. Visitors that are allowed to the facility according to the criteria determined will be notified in writing via hard copy upon entrance. To ensure compliance a log will be maintained and the email will be printed as supporting documentation.
  5. Video conferencing is offered to families and residents to optimize better communication.
  6. COVID-19 CDC reference packets were sent to families.
  7. Letters were sent to families regarding visitation restrictions including the procedures the center is implementing to protect the residents.
  8. Video clip from President/CEO were sent to families 3/21/20 -3/22/20.
  9. When the resident is diagnosed with COVID 19, the nurse/designee will notify the center leadership, physician, resident and significant other. The administrator/designee will ensure written communication is provided according to guidelines.
  10. Centers should also continue to use CDC recommended signage reminding people that anyone with symptoms of respiratory illness should not enter the facility, including employees, government officials and contractors.
  11. Ensure hand washing signage is visible in every restroom and at every hand washing sink with the appropriate soap and paper towels and a covered waste receptacle.
  12. If a resident with a COVID 19 or suspected COVID expires, in addition to following the center policies, the local department of health should be notified.

 

Employees

  1. Daily clinical updates calls are conducted with clinical corporate team, and the DONs of the centers.
  2. Daily update calls are conducted with the corporate team, Administrators and DONs of the centers.
  3. All employees must wash their hand, don a surgical face mask while in the building and practice universal precautions as per CDC guidelines and facility policy & procedures.
  4. All employees should check for any signs of illness before reporting to work each day and notify the supervisor immediately of the symptoms.
  5. Every employee must complete screening and acknowledgement of information regarding COVID 19 at least once for the center.
  6. An employee log is utilized to track as to who work in any other work places.
  7. Every employee must be screened daily upon entry to the center utilizing a COVID-19 employee daily screening form, including their recorded temperature upon arrival for
    each and every work shift.
  1. Employee temperatures will be taken and recorded on the employee temperature log at least twice a day while at work.
  2. Any employee that present with a cough or other respiratory symptoms will have their temperature taken by the nurse and followed up as appropriate in guidance with the infection preventionist/designee.
  • A COVID-19 Employee/Visitor tracking log placed in a binder is maintained at center.
  • An employee incident report is completed for any employee who displays symptoms or notifies the center representative of potential COVID-19 exposure. Please ensure number of days of self-isolation; 72 hours, 7 days or 14 days. Please provide the 14 day COVID-19 fever & symptom monitoring log to the employee.
  • If an employee develops symptoms while at work, the employee should stop working, put on a surgical mask immediately and notify their department manager or the nurse in charge/infection Preventionist/designee.
  • All employees are to wear a mask while in the center to ensure universal masking to prevent and control COVID 19.
  • Employee break times should be scheduled to allow for social distancing.
  • Dietary Employees are not to leave the kitchen area. Upon reporting to work they are to be screened and report directly to the dietary department. Breaks should be spaced to allow for social distancing.
  • Any employee that has worked in another location with confirmed or suspected cases must report this to the Director of Nursing /Infection Preventionist or their immediate supervisor.
  • Follow HR sick leave policies that allows employees to stay home if they have symptoms of COVID 19 or any respiratory infection.
  • Any employee that has visited out of state or another country must report to the Director of Nursing, Infection Preventionist or Administrator and will be asked to selfisolate for 7-14 days.
  • Employees are offered free meals during their shift to minimize external exposure.
  • A blackout period has been implemented for employee vacation requests. Any scheduled vacations are to be cancelled.
  • PPE supply totals are uploaded to a corporate SharePoint portal daily and the need of each center is addressed appropriately.
  • Recruiting efforts have been ramped up and front-line employee postings have been sponsored on Indeed.
  • Center Orientation was abbreviated, while meeting federal and state requirements, to allow for prompt onboarding of new employees.
  • Essential employee letters pertaining to COVID-19 were sent to all employees through PC Payroll and emailed to center Administrators.

 

Residents

  1. All residents should be screened for fever and other COVID 19 symptoms including vital signs AND pulse oximetry every 8 hours (Q8 hours).
  2. The residents will be identified into a minimum of three cohort groups:
    1. Individuals who are showing symptoms of COVID-19 or who have tested positive for COVID-19;
    2. Individuals who have been exposed to someone who has tested positive for COVID-19 or has shown symptoms of COVID-19 (i.e, individuals who are not themselves symptomatic, but may potentially be incubating the virus); and
    3. Individuals who are not ill and have not been exposed
  3. All residents who are admitted/readmitted and have tested positive for COVID-19 and newly diagnosed residents for COVID-19 will be isolated in a private room for the first 7 days (7 days is the minimum requirement) to prevent the transmission of the disease.
  4. Room doors of residents who are diagnosed with COVID 19 or Presumptive COVID 19 should be kept with the door closed except when entering or leaving the room, and entry and exit should be minimized.
  5. Place appropriate isolations signage on the door or wall outside of the resident room that clearly describe the type of precautions needed and required PPE. Make necessary PPE available in areas where resident care is provided.
  6. Track or create a log of all staff members that enter a confirmed COVID-19 or presumptive COVID- 19 resident’s room.
  7. Dedicated medical equipment should be used when caring for residents with known or suspected COVID-19. If not possible, clean and disinfect equipment before use with another resident within that cohort.
    1. All non-dedicated, non-disposable medical equipment used for resident care should be cleaned and disinfected according to manufacturer’s instructions and facility policies
  8. If residents have been screened and their testing is POSITIVE for COVID-19 OR if residents have signs/symptoms of a respiratory viral infection:
    1. Full Vitals AND pulse oximetry every 4 hours (Q4hours) {twice a shift}
    2. Private Room or Cohort with another symptomatic/positive resident
    3. Maintain Standard, Contact and Droplet Precautions
    4. Signage to indicate that the room is Droplet, contact Precaution outside the room.
    5. Consider that staff caring for positive or symptomatic residents do NOT care for negative or asymptomatic residents.
    6. Positive or symptomatic residents should be wearing a surgical mask when close contact with others is anticipated.
  9. Any resident identified with symptoms of fever and lower respiratory illness (cough, shortness of breath, sore throat) should be immediately placed in Droplet transmissionbased precautions.
    6 Rev- 4-14-20
  10. The isolation should be implemented by the healthcare member who discovers the symptoms pending a physician order.
  11. Residents with confirmed COVID19 or displaying respiratory symptoms should receive all services in room with door closed (meals, physical and occupational therapy, activities, and personal hygiene, etc.)
  12. Symptomatic residents should only leave their room as required for medical procedures not available on site (i.e., dialysis, medical specialist appointment, and critical testing not available at the facility). If the resident is to leave room for these purposes the shortest route should be utilized and the immediate are/route to the exit/treatment areas should be cleared of all residents and unnecessary staff.
  13. Testing to rule out routine pathogens may be completed via rapid influenza testing and respiratory viral panels (Rhinovirus, RSV, etc.).
  14. Determination to send the resident to the hospital should be based on the same criteria used for other illnesses.
  15. Those residents with severe illness requiring hospitalization should be transferred to the hospital with notification to EMS and the receiving hospital.
  16. If a COVID outbreak is suspected, paper napkins, disposable flatware and disposable cups should be utilized in all centers.
  17. COVID-19 testing procedure and protocols has been implemented and guidelines for obtaining swabs had been sent out and reviewed.
  18. If a resident is displaying symptoms of COVID-19 please call ahead to appropriate centers report prior to transfer.
  19. If a resident is discharged, COVID -19 specific information will be provided to the resident/significant other and assessment/screen will be completed and documented.
  20. Terminal cleaning utilizing infection control practices will be performed after discharge of the COVID 19 residents.

 

Admissions

Prior to Admissions:

  1. Pre-Admission COVID screen will be completed, reviewed and any concerns will be followed up appropriately.
  2. Review the referral to assess, screen and evaluate residents with potential signs and symptoms of respiratory infections to enable the facility to prevent and control COVID-19.
  3. Assess resident’s symptoms of respiratory infection upon admission including the symptoms of COVID-19 (fever, cough and shortness of breath) to the facility and implement appropriate infection prevention practices for incoming symptomatic resident.

 

Prevent the introduction of respiratory germs INTO the center

  • Post signs / visual alerts at the entrance providing information on hand hygiene, respirator hygiene, cough etiquette and instructing essentials visitors not to visit if they have symptoms of
    respiratory infections.
  • Post signs related to COVID-19 including information to speak to the receptionist or nursing supervisor if they have any questions or concerns.
  • Encourage staff and residents in getting flu vaccine, taking everyday preventive actions to help stop the spread of germs, and taking flu antivirals if prescribed.
  • Ensure supplies (tissues, waste receptacles, and alcohol-based hand sanitizers) are available.
  • All essential visitors need to sign in and out of the facility and the compliance of this should be monitored by the Administrator/designee of the center.
  • Follow HR sick leave policies that allows employees to stay home if they have symptoms of respiratory infection.

 

Prevent the spread of respiratory germs WITHIN the center

  • • Keep residents and employees informed.
    • The DON/Infection Preventionist/ Designee will be answering questions and explaining what they can do to protect themselves and their fellow residents.
  • Monitor residents and employees for fever or respiratory symptoms.
    • Restrict residents with fever or acute respiratory symptoms to their room. If they must leave the room for medically necessary procedures, they must wear a facemask (if
      tolerated). The DON/Infection Preventionist/Designee will follow the CDC criteria to guide evaluation of Persons under Investigation, (PUI) for COVID -19.
    • In general, for 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).
    • The DON/Infection Preventionist/Designee should monitor their local and state public health sources to understand COVID-19 activity in their center.
    • If there is transmission of COVID-19 in the center, in addition to implementing the precautions above, the DON/Infection Preventionist/Designee/ administrator will consult with local public health officials.
  • Support hand and respiratory hygiene, as well as cough etiquette by residents, visitors, and employees.
    • Ensure employees clean their hands according to CDC guidelines.
    • Alcohol-based hand rub is available in the center.
    • Make sure tissues are available and sink is well-stocked with soap and paper towels.
  • Identify dedicated employees whenever possible to care for resident under investigation of COVID -19 and or who have confirmed COVID-19 residents and provide infection control training.
  • Provide the right supplies to ensure easy and correct use of PPE.
    • Place appropriate isolation signage on the door or wall outside of the resident room that clearly describe the type of precautions needed and required PPE.
    • Make necessary PPE, including facemasks, eye protection, gowns, and gloves, available immediately outside of the resident room.
    • Position a trash can near the exit inside any resident room to discard PPE prior to exiting or before care to another resident in the same room.
  • Prioritize rounding in from well residents to ill residents to minimize cross contamination.
  • Evaluate environmental cleaning protocols and increase routine cleaning of high touch surfaces and shared medical equipment using EPA registered disinfectants.

 

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.
  • A log was created to track employees who work in additional communities.

Policy: Prevention and Control of the Corona Virus – COVID-19

Spring Hills Senior Communities, LLC 2020