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Infection Prevention and Control Precautions for COVID-191 Care for asymptomatic residents with no diagnosis of COVID-19 with or without known exposureStandard precautions should be followed when caring for any patient. If Patients who are afebrile (temperature less than 100.0oF and lack of respiratory symptoms (cough, sore throat, shortness of breath) then any precautions specific to COVID-19 are not required unless necessary for other infectious disease. Strict standard precautions should be required during EACH patient encounter. (see Standard Precaution Procedures). Care for residents with unknown symptoms or historyUntil a resident is determined to be symptom-free, personnel should wear all COVID-19 recommended PPE for each patient encounter. (See Transmission-based Precautions Guidelines)Care for residents with non-specific sore throat, body aches, fatigue, nausea, and diarrheaUntil known otherwise, persons with these symptoms should be treated as potentially contagious. Persons with a temperature lower than 100.0oF and the inclusion of any of these mild and non- specific symptoms should be cared for using Transmission- based precautions. Care for residents with diagnosed COVID-19/or for Community TransmissionOnly essential personnel should enter rooms of residents with COVID – 19. Transmission based precautions are required until the resident meets the criteria for discontinuance or community based transmission ceases. Airborne infection isolation rooms are not required. Cleaning for resident areas for residents with active COVID-19Only essential personnel should enter rooms of residents with COVID-19. Direct care giving staff may be assigned to daily cleaning and disinfecting of high touch surfaces since they will already be in the room providing care. All personnel entering the room must use Transmission based precautions. PPE should be removed upon leaving the room, immediately followed by strict hand hygiene. After the period of contagion, cleaning staff may conduct terminal cleaning, but delay entry into the room until a sufficient time has elapsed for air changes to remove potentially infectious particles. At that time, a gown and gloves should be used. A facemask and eye protection should be added if required for the selected cleaning products. Shoe covers are not necessary. Collection of specimens for COVID -19Healthcare personnel should wear an N95 or higher level respirators, or facemask if a respiratory is not available, eye protection, gloves, and a gown. If respirators are not easily available, they should be reserved for procedures at higher risk for producing infectious aerosols instead of collecting swabs. Standard Based Precautions1During personal care, avoid unnecessary touching of surfaces in close proximity to the resident to prevent both the contamination of clean hands from environmental surfaces and transmission from contaminated hands to surfaces; do not wear artificial fingernails or extenders if duties include contact with residents at risk for infection2When hands are visibly dirty, wash with an soap and water – an antimicrobial soap is recommended but not required 3 When hands are not visibly soiled, or after cleansing with non-antimicrobial soap, utilize an alcohol based rub4Perform hand hygiene in the following situationsBefore contact with residentAfter contact with patients skin, and after contact with any body fluids, mucous membranes, non-intact skin, would dressingsAfter moving from a contaminated body side to a clean body site during resident careAfter contact with inanimate objects including medical equipment in the immediate vicinity of the patientBefore donning and after removing gloves5Wear PPE when anticipated interaction includes contact with blood or body fluidsWear gloves when anticipating that contact with blood or other potentially infectious materials, mucous membranes, non-intact skin, or contaminated areas could occurWear a gown to protect skin and prevent soiling of clothing during procedures and activities that could cause contact with blood, body fluids, or excretionsUse protective eyewear and a mask of face shield to protect eyes, nose, and mouth during activities that could generate splashes or sprays of blood, body fluids, secretions and excretions. Remove and discard PPE – other than respirators – upon completing tasks before leaving the resident room or care area. Respirators should be removed and discarded or reprocessed after leaving the patient room and closing the doorDo not use the same gown or gloves for care of more than one resident. Remove and discard disposable gloves upon completion of a task or when soiled during care. Do not wash gloves for reuse.6Ensure appropriate respiratory hygiene and cough etiquette to reduce the transmission of respiratory illnessPrompt residents and visitors with symptoms of respiratory infection to contain their secretions and conduct hand hygiene after contact with respiratory secretions by providing tissues, masks, hand hygiene supplies throughout the facilitySeparate residents with respiratory symptoms from others as soon as possibleTransmission Based Precautions for Known or Suspected COVID-19 OR Sustained Community Transmission21 Use transmission based precautions for anyone with suspected or confirmed COVID-192Implement additional precautions: contact, droplet, airborne for patients with documented or suspected diagnoses where contact with the resident, body fluids or their environment presents a transmission risk. Use these precautions in addition to standard precautions. For COVID-19 All three types of transmission precautions are required3Place the resident in a single room; residents who test positive for COVID -19 can share rooms. These persons should be housed as far away from other residents as much as possible – especially residents at high risk 4Combined contact, droplet, and airborne precautionsWear gloves whenever resident contact is anticipated, or touch to surfaces or articles of the resident or in close proximity to the resident. Don gloves upon entry into the roomDon a mask upon entry into the room along with eye protection.Wear a gown when entering the room to avoid direct contact with resident skin or potentially contaminated surfaces or equipment – remove gloves and gown and perform hand hygiene before leaving the resident roomAfter glove and gown removal, ensure that clothing and skin do not contact potentially contaminated environmental surfaces that could result in transmissionWear a fit-tested NIOSH approved N95 or higher respirator for protection when entering the room of a resident with suspected or confirmed COVID-19/See guidance for conserving PPE for other optionsLimit transport of the resident unit to medically necessary purposes only. If transport is needed, the resident should be wearing a surgical mask, and have completed hand hygiene. Residents should also be following respiratory hygiene and cough etiquette. Remove and dispose of contaminated PPE and perform hand hygiene before transporting the resident. Don clean PPE to handle the resident at transport destination. Healthcare personnel need not wear a mask (unless all staff using masks in sustained community transmission) when transporting residents who are wearing a mask and contact is contained Use disposable patient care equipment or patient dedicated use equipment. Before transferring equipment use to other residents, ensure cleaning and disinfecting based on manufacturer and EPA guidelines. Rooms should be cleaned and disinfected on a daily basis with a focus on frequently touched surfacesChange PPE and perform hand hygiene between contact from one COVID-19 positive patient to anotherRestrict highly vulnerable health care personnel from entering the roomPersonal Protection Equipment Guidelines for PPE3Staff No Cases and No Sustained Community TransmissionFor COVID –19 Suspected or Present ORfor Sustained Community TransmissionDirect Care/Licensed Nurses Strict Standard Based Precautions for all ResidentsFrequent hand hygieneRespiratory EtiquetteGloves when interaction includes contact with blood or body fluidsGowns to protect skin and prevent soiling of clothing if contact with blood or body fluidsWhen used, remove and discard PPE other than respirators for disposal inside the room, except for respirators if usedDo not reuse equipment unless there is a policy for prioritizing PPEAs per 4/2/2020 CMS Guidance All Staff in Facilities should wear masksTransmission Based Precautions for all residents where there are known COVID cases; and for individuals who are suspected Gloves, gown, mask and eye protection for all care to COVID-19 suspected or confirmed residents. All staff use of masks while in facilityUse fit-tested NIOSH approved N95 or higher respiratory mask when entering room with suspected or known COVID-19 (See CDC PPE Conservation Protocols)Remove and dispose of all contaminated PPE before leaving room/Change PPE and use hand hygiene between residents Use disposable equipment –suspected/confirmed infectionFor reusable equipment, disinfect based on manufacturer and EPA guidelines Restrict highly vulnerable staff from entering resident roomsCohort COVID-19+ residents and provide consistent staff ResidentsEncourage frequent hand hygiene and respiratory etiquetteLimit movement in facility, support social distancing. If COVID -19 is in the facility, confine residents to rooms when able.Residents should wear surgical masks when leaving room and have completed hand hygiene. Encourage residents to follow respiratory hygiene and cough etiquette. HousekeepingNormal Cleaning ProtocolsUtilize PPE as for direct care workers when cleaning rooms of suspected or confirmed cases. Use masks and gloves. Consider using direct care workers for cleaning to reduce exposure. Clean resident rooms daily using EPA-approved disinfectants and thorough cleaning of frequently touched surfaces and bathrooms. All housekeeping staff should wear masks as other staff and gloves for cleaning. Full PPE as above for resident unit cleaning for residents with suspected or confirmed disease. Recommended resources: CDC Strategies to Optimize Supply of PPE and Equipment and Discontinuation of Precautions for COVID-19 ................
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