COVID-19 and LTC February 10, 2022 - Guidance and responses were provided based on information known on 2/10/2022 and may become out of date ...
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Guidance and responses were provided based on information known on 2/10/2022
and may become out of date. Guidance is being updated rapidly, so users should look
to CDC and NE DHHS guidance for updates.
COVID-19 and LTC
February 10, 2022
Presentation Information:
Panelists today are:
Dr. Salman Ashraf salman.ashraf@unmc.edu
Kate Tyner, RN, BSN, CIC ltyner@nebraskamed.com
Margaret Drake, MT(ASCP),CIC Margaret.Drake@Nebraska.gov
Sarah Stream, MPH, CDA, FADAA sstream@nebraskamed.com
Josette McConville, BSN, RN, CIC jmcconville@nebraskamed.com
Rebecca Martinez, BA, BSN, RN, CIC remartinez@nebraskamed.com
Jody Scebold, EdD, MSN, RN jodscebold@nebraskamed.com
Chris Cashatt RN, BSN, CIC ccashatt@nebraskamed.com
Daniel Taylor, DHHS Daniel.Taylor@nebraska.gov
Becky Wisell, DHHS Becky.Wisell@nebraska.gov
Cindy Kadavy, NHCA cindyk@nehca.org
Kierstin Reed, LeadingAge Kierstin.reed@leadingagene.org
Debi Majo, BSN, RN Deborah.Majo@tmf.org
Carla Smith, RN, CDP, IP-BC, AS-BC Carla.Smith@tmf.org
Moderated by Marissa Chaney MaChaney@nebraskamed.com
Slides and a recording of this presentation will be available on the ICAP website:
https://icap.nebraskamed.com/covid-19-webinars/
Use the Q&A box in the webinar platform to type a question. Questions will be read aloud by the moderator.
If 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 IPs.
Continuing Education Disclosures ▪1.0 Nursing Contact Hour and 1 NAB Contact Hour is awarded for the LIVE viewing of this webinar ▪In order to obtain nursing contact hours, you must be present for the entire live webinar and complete the post webinar survey ▪No conflicts of interest were identified for any member of the planning committee, presenters or panelists of the program content ▪This CE is hosted Nebraska Medicine along with Nebraska ICAP and Nebraska DHHS ▪ Nebraska Medicine is approved as a provider of nursing continuing professional development by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation
TMF Health Quality Institute
CMS Quality Improvement
Organization
Carla Smith, RN, CDP, CMDCP, IP-BC, AS-BC
Quality Improvement Specialist
NHSN Updates Coming
February 2022
• Therapeutics Pathway - There will be an update
that will categorize the listed Therapeutics by
medication type
• Weekly NHSN COVID-19 Vaccination Data Modules
› Question on individuals eligible for an additional dose or
booster dose will be removed
› Vendors are included under the “other contract
personnel” category if they are regularly scheduled to
work in the facility.
› See the FAQs on Reporting COVID-19 Vaccination Data.
5
Add new Users and/or Increase
Access to Level 3
• How to Add a User to NHSN
• Go to Increasing LTCF SAMS Level Access to NHSN.
All facilities are strongly encouraged to have at
least two registered users with Level 3 access.
• See the SAMS Identity Verification Documents first.
• Email nhsn@cdc.gov with “SAMS LEVEL 3 ACCESS”
in the subject line for assistance with any questions
related to this process.
6Recordings of TMF Training
• NH Office Hours: Engaging Residents and Caregivers
in Promoting Vaccines and Boosters – Program held
February 2, 2022
7Upcoming TMF Training
• February 15, 2022 - Nursing Home Office Hours:
Open Q&A Session @ 10:30 a.m. CT
Register Feb. 15 NH Office Hours
• February 17, 2022 - LTC Connect: Using NHSN
Entrust Soft Token and Reporting Vaccine Boosters
@ 1:30 p.m. CT
Register Feb. 17 LTC Connect
8Upcoming TMF Training
• February 22, 2022 - Nursing Home Office Hours:
Use Fuel Not Friction @ 10:30 a.m. CT
Register Feb. 22 NH Office Hours
• March 1, 2022 – Nursing Home Office Hours
at 10:30 a.m. CT
Register March 1 NH Office Hours
9Need Assistance? Email nhnetwork@tmf.org. Submit requests for help with NHSN and/or quality improvement assistance. This material was prepared by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 12SOW-QINQIO-NH-21-64-10-20-21
Nebraska Statistics
https://covidactnow.org/?s=22441170Daily New Infection Positive Test ICU Capacity Vaccinated
Week Cases/ 100K Rate Rate Used 1+
8/12/21 19.0 1.25 15.9% 75% 55.3%
Nebraska Statistics
8/26/21
9/9/2021
32.1
35.8
1.22
1.07
17.2%
16.0%
80%
75%
56.7%
58.0%
9/23/2021 40.0 1.00 14.4% 77% 58.8%
10/7/2021 31.7 0.95 11.5% 79% 59.7%
10/21/2021 29.7 0.95 10.3% 81% 60.4%
11/4/2021 32.8 1.00 13.9% 78% 61.0%
11/18/2021 44.7 1.09 14.9% 80% 62.6&
12/2/2021 38.1 0.94 17.6% 80% 63.7%
12/16/2021 46.1 1.01 16.2% 83% 65.3%
12/30/2021 46.1 1.04 16.2% 82% 66.3%
1/13/2022 174.6 1.22 35.9% 84% 67.2%
1/20/2022 215.0 1.31 35.6% 82.0% 67.4%
1/27/2022 211.4 1.11 37.7% 78% 68.4%
2/3/2022 104.8 0.80 30.8% 79% 68.7%
2/10/20 53.6 0.57 28.4 84% 68.9%
https://covidactnow.org/?s=22441170Nebraska LTC Facility COVID-19 Cases **Updated: 2/7/2022 Source: Unofficial Counts Compiled by Nebraska ICAP based on data reported by facilities and DHHS; Actual numbers may vary slightly
Vaccination Rates in LTC
PPE and Zoning
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2022/02/Zones-and-PPE-2.2022.pdf
PPE and Zoning
Red Zone Light Red Zone
• Residents with a positive COVID- • Residents suspected of having
19 Test COVID-19 but awaiting
• COVID-19 Full PPE confirmation of the diagnosis.
• Designated zone with designated Note: do not transfer to the
staffing is ideal; Room door COVID UNIT yet. Isolate in a
closed; Communal activity and private room within the yellow
dining are restricted; and therapy zone
or bathing are preferably • COVID-19 full PPE
performed in the resident room • Room door closed; Communal
[unless spa is located in the activity and dining are restricted;
COVID-19 unit]. and therapy or bathing are
preferably performed in the
resident room
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2022/02/Zones-and-PPE-2.2022-1.pdfPPE and Zoning
Yellow Zone Modified Yellow Zone
• Asymptomatic residents who have • Asymptomatic residents who have
been exposed to COVID-19 and been exposed to COVID-19 and
are not up to date on are up to date on vaccination.
vaccination. • Respirator and Eyewear/ Face
• COVID-19 Full PPE shield
• Room door closed; Communal • Resident room door closed when
activity and dining are restricted; unmasked in their room. Resident
and therapy or bathing may be should mask in communal areas,
performed in the designated gym when possible. If the resident
or bathhouse if additional cannot mask, additional
precautions are put in place accommodations should be put in
place to reduce risk.
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2022/02/Zones-and-PPE-2.2022-1.pdfPPE and Zoning
Green Zone Gray Zone
• Asymptomatic residents without any • Residents that are not up to date on
exposure to COVID-19 vaccination, without known exposure
• Source Control, Eyewear as needed for to COVID-19 who are being
Standard Precautions transferred from the hospital/ outside
• Resident masking in communal areas facilities are kept in this zone for 7
is recommended in facilities in days if they remain asymptomatic and
communities with moderate to high test negative for COVID-19 at the end
COVID-19 transmission rates. of day 7 will be moved to the Green
Zone.
• COVID-19 full PPE
• Room door closed; Communal activity
and dining are restricted; and therapy
or bathing may be performed in the
designated gym or bathhouse if
additional precautions are put in
place
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2022/02/Zones-and-PPE-2.2022-1.pdfPPE in COVID-19 Unit
PPE Required: PPE Required:
N95, Face Shield/ Eyewear, N95, Face Shield/ Eyewear,
Gown, Gloves Gown, Gloves
Res. Room Res. Room
Door Closed Door Closed
Exit Exit
N95, Face Shield/ Eyewear
Door Door
Required in Hallway Med
Closed Closed
Cart
Res. Room Res. Room
Safe Door Closed Door Closed
Space to PPE Required:
PPE Required:
Doff N95,
Face N95, Face Shield/ Eyewear, N95, Face Shield/ Eyewear,
shield/ Gown, Gloves Gown, Gloves
EyewearWhat about modified yellow
zone in memory care units?
Memory care units create a unique and challenging environment. Consider
the following with those residents that qualify for a modified yellow zone:
1. Try to keep everyone masked as much as possible
1. Have someone available to remind residents to put their masks on/
keep their masks on
2. Try to maintain physical distancing as much as possible
1. Ideally 6 feet during structured activities like dining but if not
possible maintain as much distance as you can
2. Have someone available to remind residents to keep their distance
3. Try to promote hand hygiene as much as possible
1. Provide appropriate hand hygiene supplies
2. Have someone available to remind/ assist residents practice hand
hygieneCDC Updates
CDC FAQ Update (2/9/22)
Clinical Questions about COVID-19: Questions and Answers | CDC [cdc.gov]
Infection Control
• How should isolation and quarantine recommendations be applied to
outpatients and visitors in healthcare settings?
• Can self-tests (also known as over-the-counter or home tests) be used
when determining when healthcare personnel (HCP) with SARS-CoV-2
infection or higher-risk exposures may return to work?
• If healthcare personnel (HCP) are living with someone who has been
diagnosed with SARS-CoV-2 infection, should they be excluded from
work? If so, for how long?How should isolation and quarantine
recommendations be applied to outpatients
and visitors in healthcare settings?
Refer to the full FAQ answer for details but key points are below:
• If infected, defer non-urgent appointments and visits until they meet criteria to
discontinue to isolation applied to patients in healthcare settings.
• If can’t be deferred, use transmission-based precautions.
• If they have had close contact and are not up to date with COVID-19 vaccinations;
• Defer non-urgent appointments and visits until they meet criteria to discontinue
to quarantine, postpone for 10 days have passed since last exposure.
• If can’t be deferred; they are to use well-fitting source control and physically
distance, HCP use full COVID-19 PPE.
• If they have had close contact and are up to date with COVID-19 vaccinations;
• Recommend deferring non-urgent appointments and visits until they meet criteria
to discontinue to quarantine, postpone for 10 days have passed since last
exposure.
• If not deferred; they are to use well-fitting source control and physically
distance. No additionally PPE for HCP.
CDC - Clinical Questions about COVID-19: Questions and AnswersIf HCP are living with someone who is diagnosed
with SARS-CoV-2 infection, should they be
excluded from work? If so, for how long?
Refer to the full FAQ answer for details but key points are below:
• HCP with exposures in the community should be managed in the same way that HCP with
exposure in a healthcare facility are managed.
• The most conservative approach is to consider the infected individual to be infectious until 10
days following their symptom onset (assuming they don’t meet criteria for longer isolation).
• HCP who are not able to avoid ongoing close contact with the infected individual while
contagious, should be managed as follows:
• If they are not up to date with all recommended COVID-19 vaccine doses, work
restriction should include the entire exposure period when their household contact is
potentially infectious (generally 10 days) and extend through the recommended
postexposure quarantine period.
• If they are up to date with all recommended COVID-19 vaccine doses, they do not require
work restriction unless they develop symptoms, test positive for SARS-CoV-2 infection,
are moderately to severely immunocompromised, or are otherwise advised to be
excluded from work by their occupational health program or public health authorities. If
these HCP continue to work, they should be tested immediately (but not earlier
than 24 hours after the initial exposure) and, if negative, again every 3 to 7 days
with the final test occurring 5 to 7 days after their last exposure.
CDC - Clinical Questions about COVID-19: Questions and AnswersCan self-tests (also known as over-the-counter or home
tests) be used when determining when healthcare
personnel (HCP) with SARS-CoV-2 infection or higher-
risk exposures may return to work?
Refer to the full FAQ answer for details but key points are below:
• Using laboratory-based or point-of-care tests are generally preferred in these
situations; these tests help ensure the test was administered correctly by a trained
provider and allow for official results to be shared with occupational health services.
• Use of self-tests might be considered in some situations; however this approach:
• May inappropriately transfer the cost of testing to HCP,
• Requires trust that HCP self-administered and interpreted the test results
correctly, and
• Requires that HCP report their own results to occupational health services.
• If self-tests are used, consideration should be given to performing a second test at
least 24 hours following an initial negative test; if negative, this increases the
confidence the HCP are not infectious. Facilities could also consider having HCP
present for a proctored test to assist with ensuring appropriate collection and
interpretation. CDC has resources to assist individuals with self-testing.
CDC - Clinical Questions about COVID-19: Questions and AnswersICAP Updates and
InformationSave the date!!! LTC Med Directors and other prescribers This special edition webinar is specifically for prescribers to discuss LTC COVID-19 treatment options with Nebraska ASAP. • Treatment options and outcome data will be discussed • Availability in Nebraska • Process on ordering through ASAP • Invite all Med Directors and prescribers to attend • Live discussion to answer your questions You are invited to a Zoom meeting. When: Feb 16, 2022 05:00 PM Central Time (US and Canada) Register in advance for this meeting: https://unmc.zoom.us/meeting/register/tJMof-CspzgjEtM-sgmrBXx-eCdxyDCc1QjV After registering, you will receive a confirmation email containing information about joining the meeting.
LTC Medical Directors and Prescriber Contact Information In order to advertise this to the appropriate audience, we’d like to collect contact information of the Medical Directors and other prescribers in your facilities. Please fill out the following, short survey to let us know who would be interested in receiving more information. https://redcap.nebraskamed.com/surveys/?s=H3RWPTJ8ERPJ7FXM
https://icap.nebraskamed.com/wp-content/uploads/sites/2/2022/02/ICAP-Decision-Tree.pdf
Webinar CE Process
1 Nursing Contact Hour and 1 NAB Contact Hour is offered for attending this LIVE
webinar.
Individual surveys must be completed for each attendee.
Nursing Contact Hours: NAB:
➢ Completion of survey is required. ➢ Completion of survey is required.
➢ The survey must be specific to the
➢ The survey must be specific individual obtaining credit. (i.e.: 2
to the individual obtaining people cannot be listed on the same
survey)
credit. (i.e.: 2 people cannot
➢ You must have a NAB membership
be listed on the same survey)
➢ Credit is retrieved by you
➢ One certificate is issued monthly ➢ Any issues or questions regarding your
for all webinars attended credit must be directed to NAB
➢ Certificate comes directly from customer service.
ICAP via email ➢ ICAP can verify survey completion and
check the roster list
➢ Certificate is mailed by/on the 15th ➢ Due to NAB changes, attendance will be
of the next month submitted quarterly. ICAP will send an
email stating when 2022 credits are
ready for retrieval.
Contact Marissa with questions:
Machaney@nebraskamed.com
402-552-2881Infection Prevention and Control
Hotline Number:
Call 402-552-2881
Office Hours are Monday – Friday
8:00 AM - 4:00 PM Central Time
On-call hours are available for emergencies only
Weekends and Holidays from 8:00 AM- 4:00 PM
**Please call the main hotline number only during on-call hours**Questions and Answer
Session
Use the QA box in the webinar platform to type a
question. Questions will be read aloud by the
moderator.
Panelists:
• Dr. Salman Ashraf
• Kate Tyner, RN, BSN, CIC
• Margaret Drake, MT(ASCP),CIC
• Sarah Stream, MPH, CDA, FADAA
• Josette McConville, BSN, RN, CIC
• Rebecca Martinez, BA, BSN, RN, CIC COVID-19 Webinars - CDC Nebraska
• Jody Scebold, EdD, MSN, RN Infection Control Assessment & Promotion
Program (nebraskamed.com)
• Chris Cashatt RN, BSN, CIC
• Daniel Taylor, DHHS
• Becky Wisell, DHHS Don’t forget to Like us on Facebook
• Cindy Kadavy, NHCA for important updates!
• Kierstin Reed, LeadingAge
• Melody Malone, PT, CPHQ, MHA
• Debi Majo, BSN, RN
• Moderated by Marissa Chaney
• Supported by Margaret Deacy
• Slide support from Sarah Stream and Rebecca MartinezYou can also read
