Safe Start and DOH Guidance Update for Long Term Care - October 2021 - Department of Social & Health Services Residential Care Services Washington ...
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Safe Start and DOH Guidance Update for Long Term
Care – October 2021
Department of Social & Health Services
Residential Care Services
Washington State Department of Health
Healthcare-Associated Infections &
Antimicrobial Resistance
Housekeeping
Attendees will
be in listen only Educational webinar
mode
Participants from
Self-mute your long-term care,
lines when not regulatory and
speaking public health
Type questions into No confidential
information
the question
presented or
window. Tell us where discussed
you are from (e.g., AFH, NH)
Washington State Department of Health | 2
Introductions Healthcare-Associated Infections (HAI) Team Larissa Lewis, MPH, RN, CIC Residential Care Services Amy Abbott, LICSW, CDP Office Chief for Policy, Training, Quality Improvement, and Behavioral Health
The purpose of this meeting
• Review updates to LTCF DOH Guidance
• Testing
• Admitting during an outbreak
• Cohorting
• To review updates to LTCF Safe Start Plan
• General updates
• Essential Support Person
• This does not constitute legal advice
• Please note - Always check with your local health jurisdiction:
https://www.doh.wa.gov/AboutUs/PublicHealthSystem/LocalHealthJ
urisdictions
Washington State Department of Health | 4
Not Covered Today
Vaccination Mandate:
• L&I:
• eyeonsafety@lni.wa.gov or 1-800-4BE-SAFE
• DOH:
• doh.information@doh.wa.gov or COVID Information hotline 1-800-525-0127
• COVID.Vaccine@doh.wa.gov
Washington State Department of Health | 5
https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/data-tables/Weekly-COVID-19-Long-Term-Care-Report.pdf
Washington State Department of Health | 6
https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/data-tables/Weekly-COVID-19-Long-Term-Care-Report.pdf
Washington State Department of Health | 7
LTC Safe Start Information
https://www.dshs.wa.gov/altsa/residential-care-services/safe-start-long-term-care-plan
https://www.doh.wa.gov/Emergencies/COVID19/HealthcareProviders/InfectionPrevention
Infection Prevention Core Principles
• Screening of all who enter the facility for signs and symptoms of COVID-19
• Hand hygiene (use of alcohol-based hand rub is preferred)
• Face covering or mask (covering mouth and nose)
• Distancing of at least six feet between persons
• Instructional signage throughout the facility and proper visitor education on COVID-
19
• Cleaning and disinfecting high frequency touched surfaces in the facility often, and
designated visitation areas after each visit
• Appropriate staff use of Personal Protective Equipment (PPE)
• Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
Washington State Department of Health | 9
NEW and UPDATED DOH Guidance Washington State Department of Health | 10
**Disclaimer**
Not all DOH documents have been updated to reflect
these recent changes – please refer to the most
recent document if there are discrepancies
Washington State Department of Health | 11Key Updates to DOH Guidance
• Testing
• Routine testing for HCW according to CDC’s Levels of Community
Transmission
• Required by CMS for NH
• Recommended by DOH for other LTCFs, resources permitting
• Unit-wide testing if a single HCW or facility-acquired case is identified
• Required by CMS for NH
• Recommended by DOH for other LTCFs in coordination with LHJ
• Quarantine
• Fully vaccinated, exposed residents quarantine for minimum of 7 days
• LTCF Admissions during an Outbreak
• Pause for unit-wide testing
• Resume admissions after 14-days with no positives
Washington State Department of Health | 12CDC Levels of Community Transmission
• Testing Frequency
• Visitation
Washington State Department of Health | 13Routine Testing
Old Testing Guidance Updated Testing Guidance
According to CMS positivity According to CDC’s Levels of Community
• SNFs: Transmission
• Required - All • SNFs:
unvaccinated staff • Required - All unvaccinated
• Recommended – All staff
staff, regardless of • Recommended – All staff,
vaccination status regardless of vaccination status
• Other LTCFs: • Other LTCFs:
• Recommended – All • Recommended – All staff,
staff, regardless of regardless of vaccination status
vaccination status
Washington State Department of Health | 14Testing Frequency – Routine Staff Testing
Washington State Department of Health | 15How often should you test?
The county where your facility is located is in HIGH TRANSMISSION
You are a Skilled Nursing Facility:
Required to test unvaccinated staff twice a week, per CMS.
Recommend including vaccinated staff in routine testing.
You are an Assisted Living Facility:
Recommended to test staff twice a week, if resources are available.
You are an Adult Family Home:
Recommended to test staff twice a week, if resources are available.
Washington State Department of Health | 16Outbreak Testing
***Always test symptomatic residents and staff immediately***
• Test all staff and residents on unit where the unit/area while the new case was
during their infectious period.
• Test immediately on identifying exposure (not before post-exposure day 2)
• Test 5-7 days following exposure
• Continue every 3-7 days, until no additional cases are identified for 14 days
https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/420-334-TestingLongTermCareFacilities.pdf
Washington State Department of Health | 17Expanding Unit-based Testing
• If residents participated in activity during their infectious period that included
residents from multiple units, include all units represented
• If there was a group activity with units A, B, C, include units A, B, C in
testing
• If there is a staff member was on multiple units during their infectious period,
include all units where they were
• If a staff member was on units 1, 2, 3, include units 1, 2, 3 in testing
• Small facilities (without units) should continue facility-wide testing
• If a case is identified in a non-clinical area (e.g., kitchen), test all in that area during
the infectious period
• If cases are identified in post-exposure testing expand testing based on units where
they were during their infectious period
Washington State Department of Health | 18Who should you test and how often?
One of your staff tested positive during routine testing on 10/4 and became
symptomatic later that day. They worked on Unit 2 on 10/2 and Unit 1 on 10/3.
Who should be tested:
All staff and residents on Unit 2 on 10/2
AND
All staff and residents on Unit 1 on 10/3
How often should they be tested:
Unit 2 can be tested on 10/5 and sometime between 10/7-10/9
Unit 3 can be tested on 10/6 and sometime between 10/8-10/10
Washington State Department of Health | 19Quarantine
Old Quarantine Guidance Update
• Residents who are fully • Residents who are fully
vaccinated quarantine for 14 vaccinated quarantine for 7 days
days: • If exposed
• if exposed • Post-exposure testing
• Residents who are not fully results negative
vaccinated quarantine for 14 • Residents who are not fully
days vaccinated quarantine for 14 days
• If exposed • If exposed
• If participating in ‘high • If participating in ‘high risk’
risk’ activity activity
• If newly admitted • If newly admitted
Washington State Department of Health | 20How long would resident be in quarantine?
You receive a call on 10/1 from the daughter of a resident who tested positive for
COVID that day. The resident went to the daughter’s home on 9/30 to have dinner with
the family. The resident is fully vaccinated.
When should you test?
10/3 and again between 10/5 and 10/7
How long should they be in quarantine?
For at least 7 days from exposure and post-exposure testing has resulted
negative - at least until 10/7
Washington State Department of Health | 21Admissions During an Outbreak
Old Admission Guidance Updated Admission Guidance
• Pause admission to perform • Pause admission on unit to
facility-wide post-exposure perform unit-based outbreak
testing testing
• Follow LHJ direction • May continue admissions on
units not affected
• May resume admissions on
affected units after unit-
based outbreak testing is
negative for 14 days
• Follow LHJ direction
https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/LTCTransferRecs.pdf
Washington State Department of Health | 22Should you accept admissions?
One of your staff tested positive during routine testing on 10/4 and became
symptomatic later that day. They worked on Unit 2 on 10/2 and Unit 1 on 10/3.
Who should be tested:
All staff and residents on Unit 2 on 10/2
AND
All staff and residents on Unit 1 on 10/3
How often should they be tested:
Unit 2 can be tested on 10/5 and sometime between 10/7-10/9
Unit 3 can be tested on 10/6 and sometime between 10/8-10/10
Washington State Department of Health | 23Should you accept admissions?
• Pause admissions on Units 1 and 2 while testing is done.
• All other units may continue to receive admissions.
• Continue testing Units 1 and 2 every 3-7 days until 14 days with no new cases
identified
• Admissions may resume on Units 1 and 2 after 14 days have passed with no new
cases
Washington State Department of Health | 24PPE and Source Control in Safe Start Plans
Previous:
• Outlined specific requirements in accordance with CDC and CMS guidance
• Provided specific guidance on masking and eye protection for residents, staff, and
visitors.
• At times could be incongruent with most current guidance if there was a delay in
updates to the Safe Start Plan
Current:
• Does not provide specific guidance within the document
• Guidance is to follow most current recommendations of CDC and DOH (with links to
that guidance)
• Will help diminish temporary inconsistencies between Safe Start and CDC/DOH
guidance
Washington State Department of Health | 25Dining and Activities In Safe Start Plans
Previous:
• Outlined general requirements for vaccinated and unvaccinated persons
• Outlined Source control and social distancing guidelines
• At times could be incongruent with most current guidance if there was a delay
in updates to the Safe Start Plan
Current:
• Refers reader to the Infection Prevention and PPE/Source Control sections of
document
• Does not provide specific guidance, rather refers reader to CDC and DOH guidance
• Will help diminish temporary inconsistencies between Safe Start plan and CDC/DOH
guidance
Washington State Department of Health | 26County Transmission and Visitation
• Previous visitation restrictions based on positivity rate in the county
• New restrictions based on the transmission rate in the county:
• If county transmission rate is HIGH, and
• Less than 70% of residents vaccinates, THEN
• Unvaccinated resident visitation restricted
Washington State Department of Health | 27Essential Support Person (ESP)
• New law passed through SHB 1218 during the 2021
legislative session
• Allows for In-person access to residents by one
designated person during times when limitations are
placed on visitation
Washington State Department of Health | 28Essential Support Person (ESP)
• Essential Support Person Must be:
o At least 18 years of age;
o Designated by the resident, or by the resident's representative, if the resident is
determined to be incapacitated or otherwise legally incapacitated; and
o Necessary for the resident's emotional, mental, or physical well-being during situations
that include but are not limited to:
■ circumstances involving compassionate care
■ circumstances involving end-of-life
■ circumstances where visitation from a familiar person will assist with important continuity of
care;
■ situations where visitation from a familiar person will assist with the reduction of confusion and
anxiety for residents with cognitive impairments;
■ other circumstances where the presence of an essential support person will prevent or reduce
significant emotional distress to the resident.
Washington State Department of Health | 29Essential Support Person (ESP)
• May be assigned at any time
• If the ESP visit occurs during the following situations, the ESP must be fully
vaccinated or provide proof of a negative COVID test within the last 48 hours:
o Visit with an unvaccinated resident when the county transmission rate is high and less
than 70% of residents in the facility are vaccinated
o If the resident is COVID positive
o If the resident is in quarantine
o If the facility or unit where the resident resides is in outbreak status
• To meet the COVID testing requirement:
o For homes with testing capability this can be done at the facility using the rapid testing
method
o For homes without testing capability, the ESP will need to provide proof of a negative
test within the last 48 hours
Washington State Department of Health | 30Essential Support Person (ESP)
• Facility must allow in-person access in resident room, unless roommate does not
consent. Then must be provided private location
• Facility must develop and implement reasonable conditions on access by ESP
• The facility or home will provide the ESP with information around proper use of the
PPE including offering the information on user seal checks for a tight fitting
respirator (for example an N95 mask) that can be found on the CDC website
Washington State Department of Health | 31Essential Support Person (ESP)
• ESP visits may be temporarily suspended for failure to adhere to reasonable
conditions implemented to protect the health and safety of the RSP, staff, and
residents:
• Facility must attempt to resolve concerns with ESP prior to suspension of visits
• The suspension shall last no longer than 48 hours during which time the facility must
provide:
• Info regarding steps for ESP to resume visits
• Contact information for Ombuds and Disability Rights WA
Washington State Department of Health | 32Questions?
Q&A Every Thursday:
Send Us Your Questions Ahead of Time
Subject Line:
COVID Q&A
Email:
HAI-COVID@doh.wa.gov
Washington State Department of Health | 34Resource for LTC
Infection Control Assessment & Response (ICAR)
• Consultative, educational
assessments for LTC, including
nursing homes, assisted living,
adult family homes
• Infection prevention experts
• Focus on COVID-19 prevention
and response
• Remote or site visits available
• Coordinated with your local
health jurisdiction
• To request an ICAR:
Email: Subject Line:
HAI-COVID@doh.wa.gov ICAR Request
Washington State Department of Health | 35You can also read
