COVID-19 and LTC September 16, 2021 - Guidance and responses were provided based on information known on 9/16/2021 and may become out of date ...
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Guidance and responses were provided based on information known on 9/16/2021
and may become out of date.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
September 16, 2021
Presentation Information:
Panelists today are:
Dr. Rick Starlin rick.starlin@unmc.edu
Kate Tyner, RN, BSN, CIC ltyner@nebraskamed.com
Lacey Pavlovsky, RN, MSN, CIC lpavlovsky@nebraskamed.com
Sarah Stream, MPH, CDA, FADAA sstream@nebraskamed.com
Rebecca Martinez, BSN, BA, RN, CIC remartinez@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
Debra Sutton, RN, BS, NHA deb.sutton@jchealthandlife.org
Melody Malone, PT, CPHQ, MHA melody.malone@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
Melody Malone, PT, CPHQ, MHA
Quality Improvement Specialist
NHSN Training: Resident Impact and
Facility Capacity Pathway Updates
• Date: Monday, Sept. 20, 2021
• Time: 1:00 – 2:00 PM ET
• Register in advance for this webinar:
• https://cdc.zoomgov.com/webinar/register/WN_LV
IK4Kt-Q5O-T2v2J6QydQ
5
NHSN Training: Changes to the Weekly NHSN COVID-19 Vaccination Data Collection Forms for Long-Term Care Facilities • Date: Sept. 23, 2021 • Time: 2:00 – 3:00 PM EST • Register in advance for this webinar: • https://cdc.zoomgov.com/webinar/register/WN_w QWphrcdRvCy4ATVbJ6BpQ • Note: If you are not able to attend this session, a replay broadcast will be held on September 29, 2021. Registration links coming soon. 6
Reach out to us at:
nhnetwork@tmf.org
to submit requests for
assistance with
NHSN reporting problems
or quality improvement
assistance.
Nebraska Statistics
Daily New Infection Positive Test ICU Capacity Vaccinated
Week Cases/ 100K Rate Rate Used 1+
6/17/21 1.6 0.88 3.0% 70% 50.0%
6/24/21 1.7 0.98 3.6% 64% 50.5%
7/1/21 2.5 1.17 4.3% 63% 51.7%
7/8/21 3.6 1.26 6.1% 61% 52.0%
7/15/21 4.1 1.30 6.8% 62% 52.4%
7/22/21 6.2 1.35 10.2% 64% 52.9%
7/29/21 10.4 1.35 12.8% 70% 53.5%
8/5/21 14.6 1.31 15.1% 67% 54.4%
8/12/21 19.0 1.25 15.9% 75% 55.3%
8/19/21 24.3 1.25 15.8% 72% 56.0%
8/26/21 32.1 1.22 17.2% 80% 56.7%
9/2/21 38.0 1.18 17.1% 73% 57.5%
9/9/2021 35.8 1.07 16.0% 75% 58.0%
9/16/2021 35.5 1.00 12.6% 79% 58.2%
https://covidactnow.org/?s=22441170
Nebraska Statistics https://covidactnow.org/?s=22441170
Nebraska Post-Acute and Long- Term Care Facility COVID-19 Cases **Updated: 9/13/2021 Source: Unofficial Counts Compiled by Nebraska ICAP based on data reported by facilities and DHHS; Actual Numbers may vary slightly
Nebraska LTC Facilities in Outbreak **Updated: 9/15/2021 Source: Unofficial Counts Compiled by Nebraska ICAP based on data reported by facilities and DHHS; Actual Numbers may vary slightly
CMS and CDC Updates
Updated 9/10/2021Nursing Home and LTC CDC Update https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
https://www.cms.gov/files/document/qso-20-38-nh-revised.pdf
Outbreak Testing
QSO-20-38-NH: Testing Summary https://www.cms.gov/files/document/qso-20- 38-nh-revised.pdf
Nursing Home and LTC CDC Update
Outbreak Response
https://www.cdc.gov/coronavirus/2019-
ncov/hcp/long-term-care.htmlNursing Home and LTC CDC Update
Outbreak Response
https://www.cdc.gov/coronavirus/2019-
ncov/hcp/long-term-care.htmlNebraska ICAP Suggested Approach Nebraska ICAP has noticed that when a case is identified in the building, it is often difficult for the facilities to be sure that whether that is an index case versus there may have been ongoing transmission at the facility. Limiting testing to only close contacts may increase the risk of missing cases in the building and will be a risk for widespread outbreaks. Taking into account above-mentioned rationale and the CDC revised recommendations, ICAP is recommending the following approach at this point while we are experiencing a COVID-19 surge in the state: • Outbreak testing should be done unit wide in those units where exposures have been identified (when looking at exposures for the purpose of testing, it does not need to be a prolonged exposures; exposures for shorter than 15-minute duration should also trigger outbreak testing). Both resident and staff for those units should undergo testing regardless of vaccination status. • In general, facility-wide testing is not necessary and if a healthcare worker who tested positive never entered resident care areas and had no contacts with resident then resident testing may not be needed. Some staff (regardless of vaccination status) may still need to have outbreak testing if they had any kind of contact with the positive staff member. • Facility wide testing may be needed on a case-by-case basis where there is a suspicion for a widespread exposure or additional asymptomatic cases in the building due to the nature of the outbreak. ICAP team will assist facilities with those decisions. • Since most facilities are doing point-of-care testing instead of PCR tests which are usually less sensitive and we are identifying cases at times at the 3rd and 4th round of testing, the recommendation will be to continue outbreak testing for 14 days after the last exposure
Routine Testing of
StaffQSO-20-38-NH: Routine Testing
Note: ICAP recommends that all facilities in counties identified as blue counties should continue to test
unvaccinated staff weekly until we are confident that the data is represented accurately in the CDC COVID-19
tracker
https://www.cms.gov/files/document/qso-20-38-nh-revised.pdfNote: ICAP recommends that all facilities in counties identified as blue counties should continue to test
unvaccinated staff weekly until we are confident that the data is represented accurately in the CDC COVID-19
tracker
CDC COVID Data TrackerNursing Home and LTC CDC Update
Definitions
Note: Currently the Nebraska Data on the CDC COVID-19 tracker is not
completely accurate and many counties are mentioned as having low
community transmission when the actual transmission is higher. We will be
advising facilities to take that into account when making decisions
ICAP recommends that all facilities in counties identified as blue counties
should continue to test unvaccinated staff weekly until we are confident that
the data is represented accurately in the CDC COVID-19 tracker
https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.htmlNursing Home and LTC CDC Update
Screening Testing for HCP
Note: ICAP recommends that all facilities in counties identified as blue counties should continue to test
unvaccinated staff weekly until we are confident that the data is represented accurately in the CDC
COVID-19 tracker
https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.htmlQuarantine Updates
Nursing Home and LTC CDC Update Quarantine: Fully Vaccinated Residents https://www.cdc.gov/coronavirus/2019- ncov/hcp/long-term-care.html
ICAP Suggested Approach for Quarantine of
Fully Vaccinated Residents
Even though CDC has recommended that fully vaccinated resident may not need to be
quarantined upon an exposure, but they do recommend that the resident wear masks.
However, it is well known that mask compliance is very low in nursing home resident and they
may not even be able to follow instructions on masking, physical distancing etc.
Considering the above-mentioned facts and the CDC recommendations, ICAP is
recommending the following approach for quarantine of fully vaccinated residents:
• Quarantine requirements can be waived for those fully vaccinated resident with a
significant exposure who can reliably follow the masking, physical distancing and frequent
hand hygiene guidance. They will also need to wear their mask when a staff enters their
room and their room doors should remain close. Also note that in those units where a
significant exposure has been identified, the staff should wear N-95 masks and eye
protection even if the quarantine requirement has been waived for the resident.
• Fully vaccinated residents who cannot reliably follow the masking, physical distancing and
frequent hand hygiene guidance will need to be quarantined in yellow zone for 14 days if
they have a significant exposure (close contact within 6 feet for more than 15 minutes in a
24-hour period).Red Zone Dark Red Residents with Positive COVID-19 test COVID-19 Full PPE
(Isolation Respirator, Eye protection (Either Face shield or
zone) goggles), Isolation Gown, gloves
Gown and gloves (with hand hygiene replaced between
every resident)
Respirator and Face Shield may be worn between
residents if they are not touched
Yellow Zone Light Red Residents suspected of having COVID-19 but awaiting COVID-19 Full PPE
(Quarantine (Isolation within confirmation of the diagnosis [Note: Do not transfer to
zone) quarantine COVID-unit yet. Isolate in a private room within the yellow
zone): zone]
Yellow Zone Asymptomatic residents who may have been exposed to COVID-19 Full PPE
(quarantine COVID-19.
zone) This includes vaccinated residents if they cannot comply with
the below infection control measures.
Modified Yellow Fully vaccinated, asymptomatic residents who may have Even when quarantine [yellow zone] is waived, ICAP
Zone (modified been exposed to COVID-19 and can comply with the recommends HCW continue to wear N95 respirators
quarantine following: and eye protection when in the resident room and
zone) • Wearing a mask [including in their room, when staff are resident door must remain closed.
present],
• Willing/able to comply with testing recommendations
• Maintain social distancing from staff and other residents
• Doing hand hygiene frequently and at appropriate times.
Green Zone (COVID-19 free Asymptomatic residents without any exposure to COVID19 No respirator necessary, practice source control with
zone) surgical mask
Eye protection (Face shield or goggles) as part of
standard precautions will always be needed.
Gray Zone (Transitional zone) Unvaccinated residents without known exposure to COVID- COVID-19 Full PPE
19 who are being transferred from the hospital/outside
facilities in communities with moderate to high COVID-19
transmission rates are usually kept in this zone for 14 days
and if remains asymptomatic (and test negative for COVID-
19) at the end of 14 day will be moved to Green zoneVisitation Update
Nursing Home and LTC CDC Update
Visitation
https://www.cdc.gov/coronavirus/2019-
ncov/hcp/long-term-care.htmlSource Control Update
Source Control Source control and physical distancing (when physical distancing is feasible and will not interfere with provision of care) are recommended for everyone in a healthcare setting. While it is generally safest to implement universal use of source control for everyone in a healthcare setting, the following allowances could be considered for fully vaccinated individuals (who do not otherwise meet the criteria described above) in healthcare facilities located in counties with low to moderate community transmission. Fully vaccinated people might choose to continuing using source control if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated. Fully vaccinated HCP: Consistent with guidance for the community could choose not to wear source control or physically distance when they are in well-defined areas that are restricted from patient access (e.g., staff meeting rooms, kitchen). They should wear source control when they are in areas of the healthcare facility where they could encounter patients (e.g., hospital cafeteria, common halls/corridors). Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC
ICAP Source Control
Suggested Approach
• ALL healthcare workers (regardless of vaccination status) should
continue to practice source control when at ALL times
• Removing source control masks can be an option when all of the
following criteria can be met:
• You are in a Low Community Transmission (Blue) county, AND
• You are fully vaccinated, AND
• You are in a non-clinical, non-public area away from residents and
any visitors
• Due to the inability to access real time accurate data in the CDC
Data Tracker at this time, we recommend source control at all
timesICAP Updates
Non-Hospital Healthcare workgroup meets monthly. They welcome any facilities that would like to join this meeting. If you are interested in joining the group, email Dr. Anna Fisher.
COVID-19 Tele-ICAR Reviews • ICAP is offering COVID-19 focused virtual ICAR reviews to LTC, outpatient and acute care facilities • The review will assess the status of COVID-19 policies and procedures and offer a summary of recommendations from ICAP • Home Health Agencies fall under the outpatient umbrella and ICAP has developed a HH focused review to support our HH partners • Contact NE ICAP at 402.552.2881 to be connected with the IP responsible for the facility
Webinar CE Process
1 Nursing Contact Hour and 1 NAB Contact Hour is offered for attending this LIVE
webinar
A separate survey 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 ➢ The survey must be specific to
to the individual obtaining the individual obtaining credit.
credit. (i.e.: 2 people cannot (i.e.: 2 people cannot be listed
be listed on the same survey) on the same survey)
➢ One certificate is issued monthly ➢ You must have a NAB membership
for all webinars attended ➢ Credit is retrieved by you
➢ Certificate comes directly from ➢ Any issues or
ICAP via email questions regarding your credit must
➢ Certificate is mailed by/on the 15th be directed to NAB customer service.
of the next month ➢ ICAP can verify survey
completion and check the roster
list
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. Rick Starlin
• Kate Tyner, RN, BSN, CIC
• Lacey Pavlovsky, RN, MSN, CIC
• Sarah Stream, MPH, CDA, FADAA
• Rebecca Martinez, BSN, BA, RN, CIC
• Daniel Taylor, DHHS https://icap.nebraskamed.com/resources/
• Becky Wisell, DHHS
• Cindy Kadavy, NHCA
• Kierstin Reed, LeadingAge
• Debra Sutton, RN, BS, NHA Don’t forget to Like us on Facebook
• Melody Malone, PT, CPHQ, MHA for important updates!
• Moderated by Marissa Chaney
• Supported by Margaret Deacy
• Slide support from Lacey Pavlovsky, RN, MSN, CICYou can also read
