COVID-19 and LTC September 23, 2021 - Guidance and responses were provided based on information known on 9/23/2021 and may become out of date ...
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Guidance and responses were provided based on information known on 9/23/2021
and may become out of date.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 23, 2021
Presentation Information:
Panelists today are:
Dr. Salman Ashraf salman.ashraf@unmc.edu
Andrew B. Watkins, PharmD, BCIDP anwatkins@nebraskamed.com
Margaret Drake, MT(ASCP),CIC Margaret.Drake@Nebraska.gov
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
Debi Majo, BSN, RN Deborah.Majo@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
Resident Impact Module
• Updated this past weekend.
• Booster Vaccine in the Vaccination Status
• Positive cases only
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
REQUIRED Level 3 Access by 10/1
• Monthly reporting plans will be required to enter
weekly HCP & resident COVID-19 Vaccination data
beginning October 1, 2021.
• Level 3 access will be required to complete these
monthly reporting plans in the Long-Term Care
Facility Component.
• Facilities must have a NHSN user with Level 3
access to submit or update weekly COVID-19
vaccination data for reporting weeks starting with
week ending 10/3/2021.
7
Increase access to Level 3
• Go to: Increasing LTCF SAMS Level Access to NHSN.
Please begin this process NOW to ensure Level 3
access is secured by October 2021. We strongly
encourages all facilities to have at least 2 registered
users with Level 3 access.
• See the: SAMS identity verification document
(cdc.gov) first!
• E-mail NHSN@CDC.GOV with “SAMS LEVEL 3
ACCESS” in the subject line for any questions
related to this process.
8
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%
9/23/2021 40.0 1.00 14.4% 77% 58.8%
https://covidactnow.org/?s=22441170Nebraska Statistics https://covidactnow.org/?s=22441170
Tracking Coronavirus in Nebraska:
COVID-19 Integrated County View 9/22/2021
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 or gray
counties should continue to
test unvaccinated staff at
least weekly until we are
confident that the data is
represented accurately in
https://covid.cdc.gov/covid-data-tracker/#county-view the CDC COVID-19 trackerNebraska State Dashboard is Live Again Workbook: Covid (ne.gov)
Nebraska LTC Facilities in Outbreak **Updated: 9/22/2021 Source: Unofficial Counts Compiled by Nebraska ICAP based on data reported by facilities and DHHS; Actual Numbers may vary slightly
Nebraska Post-Acute and Long- Term Care Facility COVID-19 Cases **Updated: 9/22/2021 Source: Unofficial Counts Compiled by Nebraska ICAP based on data reported by facilities and DHHS; Actual Numbers may vary slightly
FDA Authorizes
Booster Dose of
Pfizer-BioNTech
COVID-19 Vaccine for
Certain PopulationsFinal approval will
occur after the ACIP
and CDC review
FDA Authorizes Booster Dose of Pfizer-
BioNTech COVID-19 Vaccine for Certain
Populations | FDAMonoclonal Update
Update on Distribution and Supply
• As of September 13, 2021, monoclonal antibody supply has moved back to
state-allocated distribution
• Whole state gets a weekly allotment of mAb, which is divided among
infusion facilities based on case rates, utilization, and supply on hand
• At this time, the supply for the LTC program is adequate and will not be
negatively affected by this change.
• We encourage you to continue to request mAb through our normal processes
when patients qualify
• https://redcap.nebraskamed.com/surveys/?s=74H88YD3RE
• If you are working with a local hospital and they are unable or unwilling to give
mAb to your residents based on limited supply, request through Nebraska
ASAP and we can work with these hospitals to supply doses and ensure your
patients are cared for.
• The state is aware of the LTC mAb program and has made it a priority that we
continue to have doses available to serve this patient population.Reminder: SubQ Route • We have had many facilities administer monoclonal antibodies subcutaneously over the last few weeks with positive responses. • This is an excellent option when IVs are not feasible at your facility from a staffing or policy standpoint. • 4 SubQ injections administered consecutively, using different quadrants of the abdomen or upper thighs or back of upper arms
Mitigating Staffing
ShortagesMitigating Staffing Shortages
• Maintaining appropriate staffing in healthcare facilities is
essential to providing a safe work environment for
healthcare personnel (HCP) and safe patient care
• At baseline, healthcare facilities must:
• Understand their staffing needs and the minimum number of staff needed to
provide a safe work environment and safe patient care.
• Be in communication with local healthcare coalitions, federal, state, and local
public health partners (e.g., public health emergency preparedness and
response staff) to identify additional HCP (e.g., hiring additional HCP, recruiting
retired HCP, using students or volunteers), when needed
https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.htmlMitigating Staffing Shortages Contingency Staffing Capacity Strategies • Adjusting staff schedules, hiring additional HCP, and rotating HCP to positions that support patient care activities • Cancel all non-essential procedures and shift HCP who work in these areas to support other patient care activities in the facility • Identify additional HCP to work in the facility • As appropriate, request that HCP postpone elective time off from work • Have to be careful with mental health and burn out • Developing regional plans to identify alternate care sites with adequate staffing to care for patients with SARS-CoV-2 infection • Allowing asymptomatic HCP who have had a higher risk exposure to SARS-Cov-2 (the virus that causes COVID-19) but are not known to be infected to shorten their duration of work restriction
Mitigating Staffing Shortages
Crisis Staffing Capacity Strategies
• Implement regional plans to transfer patients with COVID-19
• Allow asymptomatic HCP who are not fully vaccinated and have had
a higher risk exposure to SARS-CoV-2 but are not known to be
infected to continue to work onsite throughout their 14-day post-
exposure period
• Reasonable to approach as similar to household exposure outlined previously
• AS A LAST RESORT, if shortages continue despite other mitigation
strategies, consider allowing HCP with suspected or confirmed
SARS-CoV-2 infection who are well enough and willing to work but
have not met all return-to-work criteria to work
• Would not recommend this step unless circumstances are dire, and only after
communication with ICAP, local health department, and licensure, as they may
be able to offer alternatives.
• Preferably, this would only occur in dedicated red zones.Crisis Staffing Strategies
ONLY TO BE implemented in accordance/under the approval of the local
health department, or DHHS Health Care Facilities, ICAP AND after notifying regulatory
licensures.
DHHS contact: DHHS.HealthCareFacilities@nebraska.gov
ICAP Advises facilities against assigning COVID-19 positive asymptomatic staff to work
in the yellow or green zones due to the concerns of potential transmission.
1. HCP with confirmed COVID-19 shall only care for Red Zone/Confirmed COVID-
19 residents.
2. Cleaning and Disinfection protocols for resident rooms and common areas must
be strongly practiced, at least once daily in rooms and communal areas but may
be more frequently in areas where people congregate or work.
If allowing asymptomatic or mildly symptomatic COVID-19 positive staff to work
in the red zone, facilities should implement strict measures to protect the staff
and residents who do not have COVID-19.
Things to consider include:
• Try to staff the red zone with all positive staff (who meets the criteria to work) in all
shifts to avoid any exposures to the staff without COVID illness r those who have
COVID-19 versus those who do not.
• Identifying separate break and restroom areas and nursing stations
• Focusing on cleaning and disinfection efforts between shifts in all common areas
used by the staff.Community Outings
ICAP’s Suggested Plan for Community Outings-Updated 5/26/2021 Updated Plan can be found at https://icap.nebraskamed.com/wp- content/uploads/sites/2/2021/05/ICAP-Suggested-Plan-for-Managing-New-Admissions- Readmissions-and-Return-from-Community-Outings.pdf
Risk Assessment Template for
Community Outings
Updated template can
be found at:
https://icap.nebraskame
d.com/wp-
content/uploads/sites/2
/2021/05/COVID-19-
Outing-Risk-Assessment-
Template.pdfRisk Assessment Template for
Community Outings
Updated template can be
found at:
https://icap.nebraskamed.
com/wp-
content/uploads/sites/2/2
021/05/COVID-19-Outing-
Risk-Assessment-
Template.pdfHalloween Activity
PlanningPlanning for Halloween
High Risk Scenario:
• Having children come into the
facility to trick or treat on Halloween
• Not recommended!
Safer Alternatives:
• Have an outdoor Trunk or Treat type
of event with masks and social Thi s Photo by Unknown Author i s licensed under CC
BY-NC-ND
distancing
• Consider only inviting a small
number of children, such as
the resident’s families.
• Have a small gathering outdoors,
with spread out chairs and tables
• Family bring food/treats for the
resident to eat at the facility after
they have a visit.
• Pumpkin painting or carving activityCOVID-19 Symptoms
vs. AllergiesCOVID-19 Symptoms vs. Allergies
• COVID-19 and Seasonal Allergies both cause respiratory symptoms that are similar
• It will be important to understand the differences when screening residents and staff
• Key differences in COVID-19 symptoms:
• Fever
• Muscle and body aches
• Loss of taste and smell
• Nausea or vomiting
• Diarrhea
•Shared symptoms
• Cough
• Shortness of breath, difficulty breathing
• Fatigue
• Headache
• Sore throat
• Congestion or runny nose
•Another key difference is COVID-19 symptoms are rapid onset, Seasonal allergy
symptoms are most likely chronic and long termConsiderations for Interpretation of Antigen Tests in Long-Term Care Facilities (cdc.gov)
ICAP Updates
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. Salman Ashraf
• Andrew B. Watkins, PharmD, BCIDP
• Kate Tyner, RN, BSN, CIC
• Margaret Drake, MT(ASCP),CIC
• Lacey Pavlovsky, RN, MSN, CIC
• Sarah Stream, MPH, CDA, FADAA https://icap.nebraskamed.com/resources /
• Rebecca Martinez, BSN, BA, RN, CIC
• Daniel Taylor, DHHS
• Becky Wisell, DHHS
• Cindy Kadavy, NHCA Don’t forget to Like us on Facebook
• Kierstin Reed, LeadingAge for important updates!
• Debra Sutton, RN, BS, NHA
• Melody Malone, PT, CPHQ, MHA
• Debi Majo, BSN, RN
• Moderated by Marissa Chaney
• Supported by Margaret Deacy
• Slide support from Lacey Pavlovsky, RN, MSN, CICYou can also read
