COVID-19 Weekly Connection - Connie Knorr, BSN, RN Director of Professional Development - Nebraska Health Care ...

COVID-19
Weekly
Connection
Connie Knorr, BSN, RN
Director of Professional Development
Cindy Kadavy
Senior Vice President of Policy, Research, & Reimbursement

March 6, 2020: First case of Coronavirus in Nebraska

March 8, 2020: Two additional presumptive positive cases in
Nebraska

March 10, 2020: Fourth Case of Coronavirus reported in Nebraska

March 10, 2020: Fifth case of Coronavirus reported in Nebraska

March 11, 2020: Coronavirus declared a Worldwide Pandemic by
the World Health Organization

March 12, 2020: Total of 11 cases in Nebraska

AHCA/NCAL

AHCA/NCAL Resources
• Taking Reasonable Efforts to Prevent COVID-19
  from Entering Your Skilled Nursing Center
  guidance
   • Restrict entry to only individuals who need entry
   • Restrict activities and individuals with potential for
     exposure
   • Actively try to screen all individuals entering the building
   • Require all individuals entering the building to wash their
     hands at entry
   • Set up a process to allow remote communication for
     residents and others
• Screening Checklist
   • Recommendation questions for SNF visitors

AHCA/NCAL Resources
• Taking Reasonable Efforts to Prevent COVID-19
  from Entering your Assisted Living Community
  guidance
   • Limit entry to only individuals who need entry
   • Restrict activities or individuals with potential for exposure
   • Restrict individuals who have respiratory symptoms or
     have potential COVID-19 exposure out of an abundance
     of caution
   • Require all staff entering the building to wash their hands
     upon entry and encourage visitors to do so as well
   • Set up a process to allow remote communication

AHCA/NCAL TEMPLATE LETTER TO FAMILIES

AHCA/NCAL WATER MANAGEMENT TRAINING
https://educate.ahcancal.org/products/water-management-training

AHCA/NCAL is launching a new online training course
The 1-hour training covers:
        • what a water management plan is;
        • the essential elements of an effective water management program; and,
        • how facilities should develop and maintain comprehensive water management
           programs.
The per-individual cost is $25 (member) and $65 (non-member)
An online final test and certificate of completion are included – no CEUs
The training is for administrators, building engineers and maintenance personnel, and other
staff responsible building operations or infection prevention and control

AHCA/NCAL INFECTION PREVENTIONIST SPECIALIZED TRAINING
https://educate.ahcancal.org/p/ipco

Online, self-study program with 23 hours of training
Training content includes:
• Identification and management of common infections
• Strategies to prevent the spread of infections
• Identification and description of the steps necessary for infection surveillance, antibiotic
  stewardship, investigating, tracking and reporting infections
• Successful implementation strategies
Member cost is $450
Group purchase with discount structure is available for groups of 25 or more.

AHCA/NCAL COMPLYING WITH INFECTION CONTROL REGULATIONS
https://educate.ahcancal.org/products/complying-with-infection-control-
regulations

Online, on-demand webinar training
Content includes:
• Transmission-based precautions
• Antibiotic stewardship program
• Linens
• LTC Survey Pathways/Critical Element Pathways

NHPCO

NHPCO Resources
• NHPCO Resource Page
• COVID-19 NHPCO Factsheet

WHO

WHO Resources
• Online Training, Free
   • Operational Planning Guidelines and Partners Platform to
     Support Country Preparedness and Response
   • Infection Prevention and Control for COVID-19
   • Introduction to Emerging Respiratory Viruses and COVID-
     19
   • Critical Care Severe Acute Respiratory Infection Course
   • Health and Safety Briefing for Respiratory Distress

DHHS-ICAP

Weekly COVID-19 for LTC
Webinars
• DHHS and ICAP will be holding weekly webinars
  on Thursdays
• Next dates:
    • Thursday, March 19, 2020, 12:00 p.m. CT
    • Thursday, March 26, 2020, 12:00 p.m. CT
• Join Zoom: https://unmc.zoom.us/j/183449940
• Or Call: 669-900-6833 Code: 183 449 940
• Slides posted after call on ICAP Resources Page
  and the NHCA COVID-19 Resources Page

ICAP Resources
• Post-Acute and LTC Facility Visitor Screening
  Questions Sheet
   • Visitor screening questions
• ICAP Resources
   • Visitor Screening Log Tool for LTC
     Facilities
   • PPE Validation Checklist – evaluating
     accuracy for staff
   • Stop Sign for Visitors

CDC

CDC Updates
• Evaluating and Reporting Persons Under
  Investigation (PUI)
   • Contact your local or state health department
     immediately.
• EPA’s List of Approved Disinfectants
• Healthcare Professional Preparedness Checklist
   • Preparedness for transport and arrival of patients
     confirmed or with possible COVID-19
• Strategies for Ensuring Healthcare Systems
  Preparedness and Optimizing N95 Supplies
  Webinar

CDC Updates
• Interim Additional Guidance for Infection Prevention and
  Control for Patients with Suspected or Confirmed COVID-
  19 in Nursing Homes
    •   Education and train staff on infection control and PPE
    •   Reinforce sick leave and plan for absence
    •   Education volunteers and family
    •   Reassure family of reasons actions are taken
    •   Use electronic platforms for visits with family or telehealth when
        possible
    •   Put a trash can near the exit in each resident room so staff discard
        PPE properly
    •   Ask staff to continually monitor themselves
    •   Restrict anyone (staff or visitors) who have symptoms of respiratory
        infection, international travel in last 14 days, or contact with
        someone with COVID-19
    •   Assess patients daily for symptoms
    •   Room sharing might be necessary for those known or suspected of
        COVID-19.
    •   Minimize group activities and field trips

CDC Updates
• Interim Guidance for Implementing Home Care of People Not
  Requiring Hospitalization for Coronavirus Disease 2019
    •   Provide CDC’s guidance to family and patient

• Preventing the Spread of Coronavirus Disease 2019 in Home
  and Residential Communities
    •   Monitor symptoms and report to physician if COVID-19 suspected
    •   Household members should stay separated as much as possible and not use
        the same bed or bathroom
    •   Prohibit unessential visitors
    •   Make sure shared spaces have good air flow
    •   Patient should wear a facemask when around people
    •   Wear disposable facemask and gloves when you touch the patient’s blood,
        stool, or body fluids
    •   Avoid sharing household items
    •   Clean all “high-touch” surfaces

CDC Resources
Print Resources: Coronavirus Fact Sheet, Stop the
Spread of Germs, Coronavirus Symptoms, etc.
Videos for Patients and Families
Infection Prevention Training

SURVEY

SURVEY PRIORITY DURING COVID-19
https://www.cms.gov/files/document/qso-20-12-all.pdf

Effective immediately, survey activity is limited to the following (in Priority Order):
1.      All immediate jeopardy complaints and allegations of abuse and neglect;
2.      Complaints alleging infection control concerns, including facilities with potential
        COVID-19 or other respiratory illnesses;
3.      Statutorily required recertification surveys;
4.      Any re-visits necessary to resolve current enforcement actions;
5.      Initial certifications;
6.      Surveys of facilities/hospitals that have a history of infection control deficiencies at
        the immediate jeopardy level in the last three years;
7.      Surveys of facilities/hospitals/dialysis centers that have a history of infection control
        deficiencies at lower levels than immediate jeopardy

Protocols for Coordination and Investigation of Facilities with Actual or
Suspected COVID19 Cases
https://www.cms.gov/files/document/qso-20-12-all.pdf

When a COVID-19 confirmed case or presumptive positive case is identified, State Survey
Agencies are requested to:
• Notify the appropriate CMS Regional Office of the facility and date of resident COVID-19 or
  presumptive respiratory illness or confirmed status;
• Coordinate on initiating any Federal complaint or recertification survey of the impacted facility
  until CDC have cleared the facility for survey. The CMS Regional Office will then authorize a
  survey, if necessary;
• Ensure surveyors have all necessary Personal Protective Equipment (PPE) appropriate to allow a
  survey of the facility;
• Suspend any Federal enforcement action for any deficiencies identified until reviewed and
  approved by the CMS Regional Office.

Supply of PPE

Supply of PPE
• Order PPE supplies sooner than you normally
  would to anticipate wait time for you to receive
  order
• Contact local healthcare coalitions if down to a
  few days
• U.S. Department of Health and Human Services to
  purchase 500 million N95 respirators from Strategic
  National Stockpile

https://nema.nebraska.gov/overview/county-emergency-management-directorscoordinators

COVID-19
Discussion

What difficulties are
you facing related
to COVID-19?

What experience
have you had with
recent audits related
to infection control?

Has your facility
developed plans
that you think may
be helpful to
others?

What other resources
have you found to be
helpful?

What education would
be beneficial to better
support you during this
time?

EXAMPLES OF
COVID-19 APPROACHES

Example – Physical Therapy Provider
• Physical Therapy provider asks patients to call/text when they arrive for
  their appointment and wait in their cars
• They will receive a call/text when it is okay to enter for treatment
• RATIONALE: Minimizes time spent in waiting room with large group of
  people

Example – Hilton Hotels
In these uncertain times, I wanted to reach out to you personally about what we are doing here at Hilton
to support you and your travel plans. As the situation around novel coronavirus (COVID-19) continues to
evolve, we are doing everything we can to ensure your travel safety and provide maximum flexibility.

As it has always been, the safety and security of our guests and team members remains our highest
priority. We take great pride in maintaining the highest standards of cleanliness and hygiene. In response
to the coronavirus, we have taken additional measures developed in consultation with global and local
public health authorities to make our cleaning and hygiene protocols even more rigorous.
We have activated our regional and global response teams to provide around-the-clock assistance to our
hotels and are prepared to act swiftly should we be alerted to a case of coronavirus at one of our
properties.
At Hilton, we believe it is in challenging times like these that the power of hospitality is needed most of
all. Whether you are traveling now or in the future, our team members are ready to welcome you with
the Hilton hospitality you’ve come to expect.
Chris Nassetta
President & CEO, Hilton