COVID-19 Action Plan for Congregate Settings



COVID-19 Action Plan for Congregate Care SettingsA tool to identify who in the facility will be responsible for taking certain COVID-19-specific actions Facility leadership should direct and oversee the COVID-19 Action Plan and ensure updates are incorporated in a timely manner.When used in this document, the term “staff” refers to those providing direct care to residents or services within the facility, which may include employees, consultants, contractors, and volunteers.AdministrativeActionPerson ResponsibleDue DateDate CompleteCommentsEnsure infection preventionist has adequate time, training, and resources. Additional tasks during the pandemic may include surveillance, staff education, conducting audits, and consulting with the Minnesota Department of Health (MDH) and reporting to NHSN (if applicable).CDC recommends a full-time role for at least one person in facilities that have more than 100 residents or that provide on-site ventilator or hemodialysis services.CDC: Infection Prevention Training | LTCF (longtermcare/training.html)CDC TRAIN: Free Nursing Home Infection Preventionist Training Course (cdctrain/training_plan/3814)CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (coronavirus/2019-ncov/hcp/infection-control-recommendations.html)MDH: Long-term Care: COVID-19 (health.state.mn.us/diseases/coronavirus/hcp/ltc.html)MDH LTC Bi-Weekly COVID-19 Call Subscription (redcap.health.state.mn.us/redcap/surveys/?s=MW7LK7FY83)Develop an emergency preparedness plan to identify activation of Incident Command System (ICS). ICS is a standardized approach to the command, control, and coordination of emergency response (planning, operations, logistics, finance).MDH: Long-Term Care (LTC) Emergency Preparedness (health.state.mn.us/communities/ep/ltc/index.html)Review current CMS, CDC, and MDH guidance on conducting internal and external resident activities and communal dining. Components of review should include social distancing, wearing masks, and hand hygiene.CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html)MDH: Long-term Care: COVID-19 (health.state.mn.us/diseases/coronavirus/hcp/ltc.html)CMS: QSO-20-39-NH Nursing Home Visitation - COVID-19 (files/document/qso-20-39-nh-revised.pdf)Implement infection prevention and control measures for visitors per CDC and CMS guidance. CMS: QSO-20-39-NH Nursing Home Visitation - COVID-19 (files/document/qso-20-39-nh-revised.pdf)MDH: COVID-19 Guidance: Long-term Care Indoor Visitation for Nursing Facilities and Assisted Living Settings (health.state.mn.us/diseases/coronavirus/hcp/ltcindoor.pdf)Develop plans for a surge in numbers of COVID-19-positive residents (e.g., plan for 10, 20, 30, or more cases) and staff. Plans should include establishment and implementation of a COVID-19 unit per facility regulations. Plans should also address strategies to mitigate staffing shortages.MDH: Resident Cohorts for Respiratory Outbreaks in Long-term Care (health.state.mn.us/diseases/coronavirus/hcp/crisis.html)CDC: Strategies to Mitigate Healthcare Personnel Staffing Shortages (coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html)MDH: Defining Crisis Staffing Shortage in Congregate Care Facilities: COVID-19 (health.state.mn.us/diseases/coronavirus/hcp/crisis.html)Develop a quarantine procedure based on current guidelines for residents who were exposed to COVID-19.CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html) Maintain vaccine-preventable strategies. Ensure influenza and pneumococcal vaccinations continue. Work with local public health and pharmacy to provide COVID-19 vaccine for residents and staff. CDC: Stay Up to Date with Your COVID-19 Vaccines (coronavirus/2019-ncov/vaccines/stay-up-to-date.html)MDH: About COVID-19 Vaccine (health.state.mn.us/diseases/coronavirus/vaccine/basics.html)MDH: Long-term Care: COVID-19 (health.state.mn.us/diseases/coronavirus/hcp/ltc.html)CMS: QSO-22-07-ALL: Guidance for the Interim Final Rule - Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination (medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/guidance-interim-final-rule-medicare-and-medicaid-programs-omnibus-covid-19-health-care-staff-0)MDH: Influenza Vaccine Information For Health Professionals (health.state.mn.us/diseases/flu/hcp/vaccine/index.html)MDH: Pneumococcal Information for Health Professionals (health.state.mn.us/diseases/pneumococcal/hcp.html)SurveillanceActionPerson ResponsibleDue DateDate CompleteCommentsEstablish a process to screen all who enter the facility (staff, admits, readmits, contractors, volunteers, visitors, etc.) to identify and manage people with suspected or confirmed COVID-19 infection per CDC and CMS guidance. Record keeping should follow current industry guidance. CDC: Symptoms of COVID-19 (coronavirus/2019-ncov/symptoms-testing/symptoms.html)CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (coronavirus/2019-ncov/hcp/infection-control-recommendations.html)CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html)Residents: Actively monitor all residents upon admission and at least daily for fever (temperature ≥100.0°F) and symptoms consistent with COVID-19. Ideally, include an assessment of oxygen saturation via pulse oximetry. If residents have fever or symptoms consistent with COVID-19, implement transmission-based precautions. Increase monitoring of residents with suspected or confirmed SARS-CoV-2 infection, including assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and respiratory exam, to identify and quickly manage serious infection. During a facility outbreak, consider increasing monitoring of all residents from daily to every shift to rapidly detect those with new symptoms.CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html)Staff: Implement processes for staff screening, testing (see testing section below), exclusion, and return to work. CDC: Symptoms of COVID-19 (coronavirus/2019-ncov/symptoms-testing/symptoms.html)CDC: Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 (coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html)CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html)MDH: Health Care Worker Isolation and Quarantine Recommendations (health.state.mn.us/diseases/coronavirus/hcp/exposure.html)Use a line list to capture key information about each case, with each row representing a case and each column representing a variable (e.g., demographic, clinical and epidemiologic information). Residents:MDH: Appendix L – Infection and Antibiotic Use Tracking Tool Instructions (health.state.mn.us/diseases/antibioticresistance/hcp/asp/ltc/apxlinstructions.pdf)MDH: Appendix L – Infection and Antibiotic Use Tracking Tool Excel Spreadsheet (health.state.mn.us/diseases/antibioticresistance/hcp/asp/ltc/apxl.xlsx)Staff:MDH: Employee Illness Tracking Tool Instructions (health.state.mn.us/diseases/coronavirus/hcp/illtracktool.pdf)MDH: Employee Illness Tracking Tool Excel Spreadsheet (health.state.mn.us/diseases/coronavirus/hcp/illtracktool.xlsm)Develop a plan for testing residents and staff for COVID-19, based on CMS, CDC, and MDH guidance. Maintain a low threshold for testing, particularly for those who have been exposed to or have symptoms of COVID-19, when experiencing an outbreak, or when community transmission levels are substantial or high.CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html)CMS: QSO-20-38-NH Long-Term Care Facility Testing Requirements (files/document/qso-20-38-nh-revised.pdf)CDC: SARS-CoV-2 Antigen Testing in Long Term Care Facilities (coronavirus/2019-ncov/hcp/nursing-homes-antigen-testing.html)MDH: Long-term Care Testing: COVID-19 (health.state.mn.us/diseases/coronavirus/hcp/ltctesting.html)MDH: COVID-19 Testing Guidance for Assisted Living Facilities (health.state.mn.us/diseases/coronavirus/hcp/altesting.pdf)CDC COVID Data Tracker (covid.covid-data-tracker/#county-view)Report to MDH within one working day any positive COVID-19 cases.MDH: COVID-19 Test Reporting Requirements (health.state.mn.us/diseases/coronavirus/hcp/reportlab.html)MDH: Reporting Results of COVID-19 Tests Performed Inside Your Long-term Care Facility (health.state.mn.us/diseases/coronavirus/hcp/ltcantigenreport.pdf)More information on reporting antigen testing results: Antigen Testing (health.state.mn.us/diseases/coronavirus/hcp/ltctesting.html#antigen)Education ActionPerson ResponsibleDue DateDate CompleteCommentsProvide education on COVID-19 basics for staff, including their role in prevention and containment. (e.g., transmission, signs, symptoms, general infection control practices). Reinforce education to maintain competencies (e.g., new hires, new products, audit results, outbreak, guidance updates).MDH: Project Firstline (health.state.mn.us/facilities/patientsafety/infectioncontrol/pfl/index.html)Search COVID-19 trainings, learn COVID-19 basics, and review the latest science.CDC: Training for Healthcare Professionals (coronavirus/2019-ncov/hcp/training.html) Learn fundamentals of COVID-19 prevention for nursing home management. CMS-CDC COVID-19 Training (cms-cdc-covid-19-training)Provide education to residents, visitors, and families regarding COVID-19 response and updates. Notify residents and representatives of COVID-19 cases as outlined by CMS.CMS: QSO-20-26-NH (files/document/qso-20-26-nh.pdf)CDC: Nursing Homes and Long-Term Care Facilities (coronavirus/2019-ncov/hcp/nursing-home-long-term-care.html)Hand hygieneActionPerson ResponsibleDue DateDate CompleteCommentsEnsure alcohol-based hand rub dispensers are available and full in all common areas and in each resident room (ideally both inside and outside of the room) and other care locations. Choose hand sanitizers with at least 60% alcohol. Monitor supply of alcohol-based hand rub.CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html)Conduct routine hand hygiene audits to assure staff are performing hand hygiene when required.Audit multiple shifts and all staff. Calculate compliance rates and address identified gaps. Share audit results with staff.Provide education to staff (competency-based), residents, and visitors on effective hand hygiene practices and reinforce routinely.MDH: Hand Hygiene Print Materials (health.state.mn.us/people/handhygiene/materials.html)MDH: Project Firstline Training and Resources (health.state.mn.us/facilities/patientsafety/infectioncontrol/pfl/training/index.html)CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (coronavirus/2019-ncov/hcp/infection-control-recommendations.html)Transmission-based precautionsActionPerson ResponsibleDue DateDate CompleteCommentsEducate staff on when to put residents into transmission-based precautions (TBP) (e.g., contact plus droplet/enhanced respiratory precautions). Isolation physically separates someone who is sick with a contagious disease, like COVID-19, from people who are not sick. Quarantine physically separates and restricts the movement of people who were exposed to a contagious disease, like COVID-19, to see if they become sick.Provide ongoing re-enforcement of transmission-based precaution education. MDH: Resident Cohorts for Respiratory Outbreaks in Long-term Care (health.state.mn.us/diseases/coronavirus/hcp/crisis.html)CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (coronavirus/2019-ncov/hcp/infection-control-recommendations.html)CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html)CDC: Transmission-based Precautions (infectioncontrol/basics/transmission-based-precautions.html)Audit staff compliance with transmission-based precautions.Audit multiple shifts and all staff. Calculate compliance rates and address identified gaps.Share results with staff.Have signs readily available that can be posted near the entryway of affected resident room(s). Educate on proper posting of signage. MDH: Enhanced Respiratory Precautions (health.state.mn.us/diseases/coronavirus/hcp/ppepresign.pdf)CDC: Three Key Factors Required for a Respirator to be Effective Infographic (niosh/npptl/pdfs/KeyFactorsRequiedResp01042018-508.pdf)Personal protective equipment (PPE)ActionPerson ResponsibleDue DateDate CompleteCommentsProvide competency-based education on PPE donning and doffing for all staff including: what to wear and when (gowns, respirator, face mask, eye protection, gloves), standard precautions, source control, and for residents in transmission-based precautions. As applicable, ensure compliance with respiratory protection program, fit testing, medical evaluation, and education standards. Have references on PPE donning and doffing readily available, posted in multiple locations, and at point of care (POC):MDH: COVID-19 PPE and Source Control Grids (health.state.mn.us/diseases/coronavirus/hcp/ppegrid.pdf)CDC: Protecting Healthcare Personnel (hai/prevent/ppe.html) CDC: Sequence for Putting On PPE (niosh/npptl/pdfs/PPE-Sequence-508.pdf) CDC: Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19) (coronavirus/2019-ncov/hcp/infection-control.html) CDC: COVID-19 Personal Protective Equipment (PPE) (niosh/emres/2019_ncov_ppe.html)OSHA: 1910.134 Respiratory Protection Standard (laws-regs/regulations/standardnumber/1910/1910.134)OSHA Fact Sheet: Voluntary use of filtering facepiece respirators (N95) for COVID-19 (dli.sites/default/files/pdf/fact_voluntry_use_filtering_facepiece_respirators_for_COVID-19.pdf)MDH: Project Firstline (health.state.mn.us/facilities/patientsafety/infectioncontrol/pfl/index.html)Audit staff PPE usage and compliance (e.g., donning and doffing). Audit multiple shifts and all staff. Calculate compliance rates and address identified gaps.Share results with staff.Ensure adequate PPE supplies are available. Ensure there is a process for tracking the amount of PPE supplies on hand and update as needed.CDC: Optimizing Personal Protective Equipment (PPE) Supplies (coronavirus/2019-ncov/hcp/ppe-strategy/index.html)Using the CDC: PPE Burn Rate Calculator (coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html) is a way to monitor and predict PPE needs. If you will experience a shortage of PPE (3-7 days left of supply), follow these steps in order and escalate to the next measure, if needed:Work with usual vendor to secure supply. Escalate to regional health care coalition contact (visit MDH: Regional Health Care Preparedness Coordinators [health.state.mn.us/communities/ep/coalitions/rhpc.html]). Escalate to the state cache via REDCap. Be prepared to describe efforts to secure PPE via other routes.MDH: COVID-19 Supply Chain Resource Requests (AKA PPE REDCap Survey) (redcap.health.state.mn.us/redcap/surveys/?s=LXR9JMRYEJ) Environmental cleaningActionPerson ResponsibleDue DateDate CompleteCommentsEnsure disinfectant is EPA approved and effective against SARS-CoV-2.EPA About List N: Disinfectants for Coronavirus (COVID-19) (coronavirus/about-list-n-disinfectants-coronavirus-covid-19-0)Provide, reinforce, and document staff education on cleaning products, including:Ready-to-use or to-be-prepared (diluted/mixed) product.Effectiveness against SARS-CoV-2 virus.Contact (wet) time.Frequency of cleaning/disinfecting.MDH: Project Firstline Training and Resources (health.state.mn.us/facilities/patientsafety/infectioncontrol/pfl/training/index.html)CDC video: LTC Mini Webinar: Sparkling Surfaces: Stop COVID-19’s Spread (watch?v=t7OH8ORr5Ig)Ensure environmental services staff (or other designated staff) thoroughly clean and disinfect common areas and high touch surfaces frequently. Increase cleaning and disinfection in isolation rooms to two times a day focusing on the high touch points.Position a trash can near the exit of the resident room to make it easy for staff to discard PPE before exiting or before providing care for a roommate.Keep clean and soiled items separate. Audit compliance with cleaning and disinfection of resident rooms, common areas, clean and soiled utility rooms. Audit multiple shifts and all staff. Calculate compliance rates and address identified gaps.Share results with staff.Cleaning equipmentActionPerson ResponsibleDue DateDate CompleteCommentsReinforce staff education on equipment cleaning: every piece of equipment that is shared between residents should be cleaned and disinfected after each use. Resident designated equipment is cleaned and disinfected when soiled and according to a schedule set by the facility (i.e., after each use, daily, weekly, etc.). Determine who cleans which piece of equipment: when, how, and with what product. EPA About List N: Disinfectants for Coronavirus (COVID-19) (coronavirus/about-list-n-disinfectants-coronavirus-covid-19-0)Ensure disinfectant product(s) is easily accessible at point of care (i.e., in basket attached to equipment) if possible.Dedicate equipment to individual residents, when possible, especially items that are difficult to disinfect such as gait belts and lift slings. Dedicate equipment for use with residents known to have COVID-19.Audit compliance with cleaning and disinfection of shared resident equipment after each use. Audit multiple shifts and all staff. Calculate compliance rates and address identified gaps.Share results with staff.Inter-facility communication and transfers ActionPerson ResponsibleDue DateDate CompleteCommentsEnsure clear and consistent communication with transporter and the receiving facility when transferring a resident with known, suspect, or unknown COVID-19 status to a hospital, outpatient facility or clinic, or other congregate care setting. Facilities should be prepared to follow the requirements of a receiving facility (e.g., dialysis, preprocedural) such as paperwork, screening, and infection control measures. Plan should include how to ensure medically necessary care (e.g., dialysis, infusion care) for residents with suspected or confirmed COVID-19. CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (coronavirus/2019-ncov/hcp/long-term-care.html)Other resourcesActionPerson ResponsibleDue DateDate CompleteCommentsCOVID-19 Print ResourcesMDH: Materials and Resources for COVID-19 Response (health.state.mn.us/diseases/coronavirus/materials/index.html)CDC: COVID-19 Print Resources (coronavirus/2019-ncov/communication/print-resources.html) Other ResourcesCDC: What’s New and Updated (coronavirus/2019-ncov/whats-new-all.html)State of MN: COVID-19 Vaccinations (covid19/vaccine/index.jsp)HHS: Vaccine Adverse Effects Reporting (VAERS) (vaers.reportevent.html)To request an on-site or tele-ICAR visit, contact: health.icar@state.mn.usMinnesota Department of HealthInfection Control Assessment and Response (ICAR) ProgramPO Box 64975St. Paul, MN 55164-0975651-201-5414health.icar@state.mn.ushealth.state.mn.us/icar4/14/22To obtain this information in a different format, call: 651-201-5414. ................
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