COVID-19 IN YOUR COMMUNITYMEMBER TOOLKIT:

Table of Contents

3 Coronavirus and You (CDC)

4 Preparing for COVID-19: Long-term Care Facilities, Nursing Homes (CDC)

5 Interim Additional Guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in Nursing Homes (CDC)

11 Healthcare Professional Preparedness Checklist for Transport and Arrival of Patients with Confirmed or Possible COVID-19 (CDC)

12 COVID-19 Testing Guidelines (OSDH)

13 Planning for a COVID-19 Outbreak in Your Community (LeadingAge National)

15 Alert: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings

27 Cleaning Protocols (ISSA) and EPA Recommendations

29 Guidance to Nursing Facilities from Department of Health (effective 3/19/20)

33 10 Initial Steps When Faced with a Positive COVID-19 Diagnosis (DHS)

34 Sample Template: Memo to Employees

35 Sample Template: Memo to Residents and Families

36 Sample Template: Letter to Families Following Positive Diagnosis (DHS)

37 Sample Facebook Post

38 Sample Press Releases for Positive Diagnosis of COVID-19

39 Media Talking Points

41 COVID-19 Infection Control Sample Policy

49 Sample Policies: Unpaid Sick Leave

52 Sample Policies: Containment (Influenza Pandemic)

55 Sample Policies: Admissions (Influenza Pandemic)

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Coronavirus disease 2019 (COVID-19) and you

What is coronavirus disease 2019?

Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China.

Can I get COVID-19?

Yes. COVID-19 is spreading from person to person in parts of the world. Risk of infection from the virus that causes COVID-19 is higher for people who are close contacts of someone known to have COVID-19, for example healthcare workers, or household members. Other people at higher risk for infection are those who live in or have recently been in an area with ongoing spread of COVID-19. Learn more about places with ongoing spread at www.cdc.gov/coronavirus/2019-ncov/about/transmission.html#geographic.

The current list of global locations with cases of COVID-19 is available on CDC’s web page at www.cdc.gov/coronavirus/2019-ncov/locations-confirmed-cases.html.

How does COVID-19 spread?

The virus that causes COVID-19 probably emerged from an animal source but is now spreading from person to person. The virus is thought to spread mainly between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs or sneezes. It also may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. Learn what is known about the spread of newly emerged coronaviruses at:

https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html.

What are the symptoms of COVID-19?

Patients with COVID-19 have had mild to severe respiratory illness with symptoms of:

• fever

• cough

• shortness of breath

What are severe complications from this virus?

Some patients have pneumonia in both lungs, multi-organ failure and in some cases death.

People can help protect themselves from respiratory illness with everyday preventive actions.

• Avoid close contact with people who are sick.

• Avoid touching your eyes, nose, and mouth with unwashed hands.

• Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

If you are sick, to keep from spreading respiratory illness to others, you should

• Stay home when you are sick.

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• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

• Clean and disinfect frequently touched objects and surfaces.

What should I do if I recently traveled from an area with ongoing spread of COVID-19?

If you have traveled from an affected area, there may be restrictions on your movements for up to 2 weeks. If you develop symptoms during that period (fever, cough, trouble breathing), seek medical advice. Call the office of your health care provider before you go and tell them about your travel and your symptoms. They will give you instructions on how to get care without exposing other people to your illness. While sick, avoid contact with people, don’t go out and delay any travel to reduce the possibility of spreading illness to others.

Is there a vaccine?

There is currently no vaccine to protect against COVID-19. The best way to prevent infection is to take everyday preventive actions, like avoiding close contact with people who are sick and washing your hands often.

Is there a treatment?

There is no specific antiviral treatment for COVID-19. People with COVID-19 can seek medical care to help relieve symptoms.

Preparing for COVID-19: Long-term Care Facilities, Nursing Homes

A new respiratory disease – coronavirus disease 2019 (COVID-19) – is spreading globally and there have been instances of COVID-19 community spread in the United States. The general strategies CDC recommendations to prevent the spread of COVID-19 in LTCF are the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza.

On This Page

Preparedness Checklist

Interim Guidance for Nursing Homes

Things Facilities Should Do Now

When There Are Cases in the Community

When There Are Cases in the Facility

Symptoms of respiratory infection, including COVID-19:

Fever

Cough

Shortness of breath

Long-term care facilities concerned that a resident, visitor, or employee may be a COVID-2019 patient under investigation should contact their local or state health department immediately for consultation and guidance.

COVID-19 Preparedness Checklist for Nursing Homes and other Long-Term Care Settings

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Nursing homes and other long-term care facilities can take steps to assess and improve their preparedness for responding to coronavirus disease 2019 (COVID-19). This checklist should be used as one tool to develop a comprehensive COVID-19 response plan, including plans for:

Rapid identification and management of ill residents

Considerations for visitors and consultant staff

Supplies and resources

Sick leave policies and other occupational health considerations

Education and training

Surge capacity for staffing, equipment and supplies, and postmortem care

The checklist identifies key areas that long-term care facilities should consider in their COVID-19 planning. Long-term care facilities can use this tool to self-assess the strengths and weaknesses of current preparedness efforts. This checklist does not describe mandatory requirements or standards; rather, it highlights important areas to review to prepare for the possibility of residents with COVID-19.

COVID-19 Preparedness Checklist for Nursing Homes and other Long-Term Care Settings pdf icon [PDF – 1 MB]

Interim Additional Guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in Nursing Homes

Summary of Changes to the Guidance:

Updated guidance to recommend that nursing homes:

Restrict all visitation except for certain compassionate care situations, such as end of life situations

Restrict all volunteers and non-essential healthcare personnel (HCP), including non-essential healthcare personnel (e.g., barbers)

Cancel all group activities and communal dining

Implement active screening of residents and HCP for fever and respiratory symptoms

COVID-19 is being increasingly reported in communities across the United States. It is likely that SARS-CoV-2 will be identified in more communities, including areas where cases have not yet been reported. As such, nursing homes should assume it could already be in their community and move to restrict all visitors and unnecessary HCP from the facility; cancel group activities and communal dining; and implement active screening of residents and HCP for fever and respiratory symptoms.

Background

Given their congregate nature and residents served (e.g., older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by COVID-19. If infected with SARS-CoV-2, the virus that causes COVID-19, residents are at increased risk of serious illness.

Visitor RestrictionsIll visitors and healthcare personnel (HCP) are the most likely sources of introduction of COVID-19 into a facility. CDC recommends aggressive visitor restrictions and enforcing sick leave policies for ill HCP, even

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before COVID-19 is identified in a community or facility.

These recommendations supplement CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. These recommendations are specific for nursing homes, including skilled nursing facilities. Much of this information could also be applied in assisted living facilities. This information complements, but does not replace, the general infection prevention and control recommendations for COVID-19.

This guidance is based on the currently available information about COVID-19. It will be refined and updated as more information becomes available and as response needs change in the United States. It is important to understand transmission dynamics in your community to inform strategies to prevent introduction or spread of COVID-19 in your facility. Consultation with public health authorities can help you better understand if transmission of COVID-19 is occurring in your community.

See the COVID-19 Preparedness Checklist for Nursing Homes and Other Long-Term Care Settings. pdf icon [PDF – 1 MB]

Things facilities should do now

Educate Residents, Healthcare Personnel, and Visitors

Share the latest information about COVID-2019.

Review CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.

Educate and train HCP.

o Reinforce sick leave policies. Remind HCP not to report to work when ill.

o Reinforce adherence to infection prevention and control measures, including hand hygiene and selection and use of personal protective equipment (PPE). Have HCP demonstrate competency with putting on and removing PPE.

Educate both facility-based and consultant personnel (e.g., wound care, podiatry, barber) and volunteers. Including consultants is important because they often provide care in multiple facilities and can be exposed to or serve as a source of pathogen transmission.

Educate residents and families including:

o information about COVID-19

o actions the facility is taking to protect them and their loved ones, including visitor restrictions

o actions residents and families can take to protect themselves in the facility

Provide Supplies for Recommended Infection Prevention and Control Practices

Hand hygiene supplies:

o Put alcohol-based hand sanitizer with 60–95% alcohol in every resident room (ideally both inside and outside of the room) and other resident care and common areas (e.g., outside dining hall, in therapy gym).

o Make sure that sinks are well-stocked with soap and paper towels for handwashing.

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Respiratory hygiene and cough etiquette:

o Make tissues and facemasks available for coughing people.

o Consider designating staff to steward those supplies and encourage appropriate use by residents, visitors, and staff.

Make necessary Personal Protective Equipment (PPE) available in areas where resident care is provided. Put a trash can near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the room, or before providing care for another resident in the same room. Facilities should have supplies of:

o facemasks

o respirators (if available and the facility has a respiratory protection program with trained, medically cleared, and fit-tested HCP)

o gowns

o gloves

o eye protection (i.e., face shield or goggles).

Consider implementing a respiratory protection program that is compliant with the OSHA respiratory protection standard for employees if not already in place. The program should include medical evaluations, training, and fit testing.

Environmental cleaning and disinfection:

o Make sure that EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident care equipment.

o Refer to List N external icon on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.

Assessing Risk & Possible Restrictions for HCP

Refer to the Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19).

Evaluate and Manage HCP with Symptoms of Respiratory Illness

Implement sick leave policies that are non-punitive, flexible, and consistent with public health policies that allow ill HCP to stay home.

As part of routine practice, ask HCP (including consultant personnel) to regularly monitor themselves for fever and symptoms of respiratory infection.

o Remind HCP to stay home when they are ill.

o If HCP develop fever or symptoms of respiratory infection while at work, they should immediately put on a facemask, inform their supervisor, and leave the workplace.

o Consult occupational health on decisions about further evaluation and return to work.

Screen all HCP at the beginning of their shift for fever and respiratory symptoms.

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o Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and leave the workplace.

o HCP who work in multiple locations may pose higher risk and should be asked about exposure to facilities with recognized COVID-19 cases.

Restrict nonessential healthcare personnel (including consultant personnel) and volunteers for entering the building.

When transmission in the community is identified, nursing homes and assisted living facilities may face staffing shortages. Facilities should develop (or review existing) plans to mitigate staffing shortages.

When to End Transmission-Based Precautions

Refer to the Interim Guidance for Discontinuation of Transmission-Based Precautions and Disposition of Hospitalized Patients with COVID-19.

Policies and Procedures for Visitors

Because of the ease of spread in a long-term care setting and the severity of illness that occurs in residents with COVID-19, facilities should immediately restrict all visitation to their facilities except certain compassionate care situations, such as end of life situations.

o Send letters or emails to families advising them that no visitors will be allowed in the facility except for certain compassionate care situations, such as end of life situations. Use of alternative methods for visitation (e.g., video conferencing) should be facilitated by the facility.

o Post signs at the entrances to the facility advising that no visitors may enter the facility.

o Decisions about visitation during an end of life situation should be made on a case by case basis, which should include careful screening of the visitor for fever or respiratory symptoms. Those with symptoms should not be permitted to enter the facility. Those visitors that are permitted must wear a facemask while in the building and restrict their visit to the resident’s room or other location designated by the facility. They should also be reminded to frequently perform hand hygiene.

Resources for Confirmed or Suspected COVID-19

Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19)

Evaluating and Reporting Persons Under Investigation (PUI)

Evaluate and Manage Residents with Symptoms of Respiratory Infection

Ask residents to report if they feel feverish or have symptoms of respiratory infection.

Actively monitor all residents upon admission and at least daily for fever and respiratory symptoms (shortness of breath, new or change in cough, and sore throat).

o If positive for fever or symptoms, implement recommended IPC practices.

The health department should be notified about residents with severe respiratory infection, or a cluster (e.g., >3 residents or HCP with new-onset respiratory symptoms over 72 hours) of residents or HCP with symptoms of respiratory infections.

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o See State-Based Prevention Activitiesfor contact information for the healthcare-associated infections program in each state health department.

o CDC has resources for performing respiratory infection surveillance in long-term care facilities pdf icon [PDF – 246 KB] during an outbreak.

In general, when caring for residents with undiagnosed respiratory infection use Standard, Contact, and Droplet Precautions with eye protection unless the suspected diagnosis requires Airborne Precautions (e.g., tuberculosis). This includes restricting residents with respiratory infection to their rooms. If they leave the room, residents should wear a facemask (if tolerated) or use tissues to cover their mouth and nose.

o Continue to assess the need for Transmission-Based Precautions as more information about the resident’s suspected diagnosis becomes available.

If COVID-19 is suspected, based on evaluation of the resident or prevalence of COVID-19 in the community,

o Residents with known or suspected COVID-19 do not need to be placed into an airborne infection isolation room (AIIR) but should ideally be placed in a private room with their own bathroom.

o Room sharing might be necessary if there are multiple residents with known or suspected COVID-19 in the facility. As roommates of symptomatic residents might already be exposed, it is generally not recommended to separate them in this scenario. Public health authorities can assist with decisions about resident placement.

o Facilities should notify the health department immediately and follow the Interim Infection Prevention and Control Recommendations for Patients with COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings, which includes detailed information regarding recommended PPE.

If a resident requires a higher level of care or the facility cannot fully implement all recommended precautions, the resident should be transferred to another facility that is capable of implementation. Transport personnel and the receiving facility should be notified about the suspected diagnosis prior to transfer.

o While awaiting transfer, symptomatic residents should wear a facemask (if tolerated) and be separated from others (e.g., kept in their room with the door closed). Appropriate PPE should be used by healthcare personnel when coming in contact with the resident.

Additional Measures

Cancel communal dining and all group activities, such as internal and external activities.

Remind residents to practice social distancing and perform frequent hand hygiene.

Create a plan for cohorting residents with symptoms of respiratory infection, including dedicating HCP to work only on affected units.

In addition to the actions described above, these are things facilities should do when there are cases in their community but none in their facility.

Healthcare Personnel Monitoring and Restrictions

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Consider implementing universal use of facemasks for HCP while in the facility.

In addition to the actions described above, these are things facilities should do when there are cases in their facility or sustained transmission in the community.

Healthcare Personnel Monitoring and Restrictions:

Implement universal use of facemask for HCP while in the facility.

Consider having HCP wear all recommended PPE (gown, gloves, eye protection, N95 respirator or, if not available, a facemask) for the care of all residents, regardless of presence of symptoms. Implement protocols for extended use of eye protection and facemasks.

Resident Monitoring and Restrictions:

Encourage residents to remain in their room. If there are cases in the facility, restrict residents (to the extent possible) to their rooms except for medically necessary purposes.

o If they leave their room, residents should wear a facemask, perform hand hygiene, limit their movement in the facility, and perform social distancing (stay at least 6 feet away from others).

Implement protocols for cohorting ill residents with dedicated HCP.

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Healthcare Professional Preparedness Checklist For Transport and Arrival of Patients With Confirmed or Possible COVID-19 :

Front-line healthcare personnel in the United States should be prepared to evaluate patients for coronavirus disease 2019 (COVID-19). The following checklist highlights key steps for healthcare personnel in preparation for transport and arrival of patients with confirmed or possible COVID-19.

Stay up to date on the latest information about signs and symptoms, diagnostic testing, and case definitions for coronavirus disease 2019.

Review your infection prevention and control policies and CDC infection control recommendations for COVID-19 for:

o Know who, when, and how to seek evaluation by occupational health following an unprotected exposure (i.e., not wearing recommended PPE) to a suspected or confirmed coronavirus disease 2019 patient.

o Assessment and triage of patients with acute respiratory symptoms

o Patient placement

o Implementation of Standard, Contact, and Airborne Precautions, including the use of eye protection

o Visitor management and exclusion

o Source control measures for patients (e.g., put facemask on suspect patients)

o Requirements for performing aerosol generating procedures

o Be alert for patients who meet the persons under investigation (PUI) definition

o Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.

o Remain at home, and notify occupational health services, if you are ill.

o Know how to contact and receive information from your state or local public health agency.

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TESTING GUIDELINES:

IF YOU ARE A PROVIDER WANTING TO TEST A PATIENT

The Oklahoma State Department of Health (OSDH) recommends the following: Facilities should contact their health care provider first if they have clinical questions or suspect a resident in one of these settings to have COVID-19. OSDH may be contacted at 877-215-8336 or 2-1-1.

For testing through a commercial laboratory, consultation with a health care provider is required.

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Planning for a COVID-19 Outbreak in Your Community

Overview: Communication specific to coronavirus, caregiving, and older adults is a dynamic situation. The points below provide a framework for organizations developing messaging for media consumption and/or responding to press queries about diagnosed cases of COVID-19 in their organization. Tailor the content below, as needed, to your setting.

Guiding principles: The spread of coronavirus is a public health emergency. Transparency and open communication are crucial to establishing your organization’s credibility and ensuring that each of your audiences (i.e., the older adults living in your community and their families, your staff and your larger community, local public health officials and the general public), know the facts and view your organization as a trusted source of information. It is crucial to tell the truth, tell it first, tell it fully, and tell it fast.

Prepare. Anticipate what you will need should reporters call. Answer the following:

Who will be your spokesperson? (Pick only one.)

What is your message?

What audiences need to be addressed, and in what order? (i.e., patients, patient families, board members, staff, public, media, etc.)

What will the process be to create and approve messaging, and then distributed?

Who will have approval to create and distribute messaging; who in your organization must approve the message prior to it being made public?

What channels will be used to distribute (email, social media, website)?

If you intend to push your message out to the media, what outlets and reporters can be tapped? (if you have time and the desire to proactively reach out to media with whom you have established relationships)

Plan to inform staff that any queries about the case must be directed to your organization’s designated media spokesperson when word of a diagnosed case is shared with residents/clients, families, staff and others in your community. You want to maintain control of the message.

Anticipate follow up questions that may be asked after the diagnosed case is announced and develop a Frequently Asked Questions (FAQ) document.

NOTE:

○ While you do not have to disclose ALL details of the situation (i.e., where/how the person became infected, the person’s state of health, etc.) in your public statement, you should be prepared to respond to any question, and those responses should have the same approvals as the statement.

○ If you do not know the answer to an anticipated question, it is appropriate to say, “At this time, we do not have the answer to your question. We will provide updates as we learn more,” and then be sure to provide updates when you have them.

Execute:

Message: Keep the language simple and straightforward. Provide facts without violating privacy. Explain the steps your organization is taking to care for the sick person and to contain the virus’ spread amongst each of your audiences (i..e, other residents/clients; families and visitors; your

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staff; vendors; etc.). Emphasize your organization’s collaboration with public health organizations.

○ SAMPLE: “A [resident/client we serve/staff member] of [insert organization name] has been diagnosed with COVID-19. The [resident/client we serve/staff member] is in [what: quarantined at home/in the hospital]. We have notified public health officials as required and are following procedures recommended by the Centers for Disease Control & Prevention.”

Timing: News spreads fast. You can anticipate a call moments after learning about the diagnosis yourself. Prepare a short statement for use in the event of a diagnosed case; have approvals in place so that you can take action if necessary. When a case is diagnosed, proactive media outreach is not necessary, however you should be prepared to make a statement and be transparent. Make it easy to find information about the situation on your website with the name of your spokesperson.

Follow-up: Prepare to update your statement as the situation changes. (E.g., new cases, no more cases, etc.). You can also reasonably expect that a reporter will follow-up with you regularly. If you have promised to provide updates to reporters, do so.

Re-group: After the situation has passed, plan a time to regroup with your team to assess how the plan was executed including how to improve your processes for a future crisis event.

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Alert: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings

Updated PPE recommendations for the care of patients with known or suspected COVID-19:

• Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand. During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCP.

o Facemasks protect the wearer from splashes and sprays.

o Respirators, which filter inspired air, offer respiratory protection.

• When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Facilities that do not currently have a respiratory protection program, but care for patients infected with pathogens for which a respirator is recommended, should implement a respiratory protection program.

• Eye protection, gown, and gloves continue to be recommended.

o If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.

• Included are considerations for designating entire units within the facility, with dedicated HCP, to care for known or suspected COVID-19 patients and options for extended use of respirators, facemasks, and eye protection on such units. Updated recommendations regarding need for an airborne infection isolation room (AIIR).

o Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed. Airborne Infection Isolation Rooms (AIIRs) (See definition of AIIR in appendix) should be reserved for patients undergoing aerosol-generating procedures (See Aerosol-Generating Procedures Section)

• Updated information in the background is based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns. o Increased emphasis on early identification and implementation of source control (i.e., putting a face mask on patients presenting with symptoms of respiratory infection).

• If you have specific questions on infection control measures in addition to these guidelines, call OSDH at 1-877-215-8336.

Background: This interim guidance has been updated based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns. Here is what is currently known:

Mode of transmission: Early reports suggest person-to-person transmission most commonly happens during close exposure to a person infected with COVID-19, primarily via respiratory droplets produced when the infected person coughs or sneezes. Droplets can land in the mouths, noses, or eyes of people

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who are nearby or possibly be inhaled into the lungs of those within close proximity. The contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. However, airborne transmission from person-to-person over long distances is unlikely.

Shortage of personal protective equipment: Controlling exposures to occupational infections is a fundamental method of protecting HCP. Traditionally, a hierarchy of controls has been used as a means of determining how to implement feasible and effective control solutions. The hierarchy ranks controls according to their reliability and effectiveness and includes such controls as engineering controls, administrative controls, and ends with personal protective equipment (PPE). PPE is the least effective control because it involves a high level of worker involvement and is highly dependent on proper fit and correct, consistent use.

Major distributors in the United States have reported shortages of PPE, specifically N95 respirators, facemasks, and gowns. Healthcare facilities are responsible for protecting their HCP from exposure to pathogens, including by providing appropriate PPE.

In times of shortages, alternatives to N95s should be considered, including other classes of FFRs, elastomeric half-mask and full facepiece air purifying respirators, and powered air purifying respirators (PAPRs) where feasible. Special care should be taken to ensure that respirators are reserved for situations where respiratory protection is most important, such as performance of aerosol-generating procedures on suspected or confirmed COVID-19 patients or provision of care to patients with other infections for which respiratory protection is strongly indicated (e.g., tuberculosis, measles, varicella).

The anticipated timeline for return to routine levels of PPE is not yet known. Information about strategies to optimize the current supply of N95 respirators, including the use of devices that provide higher levels of respiratory protection (e.g., powered air purifying respirators [PAPRs]) when N95s are in limited supply and a companion checklist to help healthcare facilities prioritize the implementation of the strategies, is available.

Capacity across the healthcare continuum: Use of N95 or higher-level respirators are recommended for HCP who have been medically cleared, trained, and fit-tested, in the context of a facility’s respiratory protection program. The majority of nursing homes and outpatient clinics, including hemodialysis facilities, do not have respiratory protection programs nor have they fit-tested HCP, hampering implementation of recommendations in the previous version of this guidance. This can lead to unnecessary transfer of patients with known or suspected COVID-19 to another facility (e.g., acute care hospital) for evaluation and care. In areas with community transmission, acute care facilities will be quickly overwhelmed by transfers of patients who have only mild illness and do not require hospitalization.

Many of the recommendations described in this guidance (e.g., triage procedures, source control) should already be part of an infection control program designed to prevent transmission of seasonal respiratory infections. As it will be challenging to distinguish COVID-19 from other respiratory infections, interventions will need to be applied broadly and not limited to patients with confirmed COVID-19. This guidance is applicable to all U.S. healthcare settings.

This guidance is not intended for non-healthcare settings (e.g., schools) OR for persons outside of healthcare settings. For recommendations regarding clinical management, air or ground medical transport, or laboratory settings, refer to the main CDC COVID-19 website.

Definition of Healthcare Personnel (HCP) –For the purposes of this document, HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to

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patients or infectious materials, including body substances; contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air.

Recommendations

1. Minimize Chance for Exposures

Ensure facility policies and practices are in place to minimize exposures to respiratory pathogens including SARS-CoV-2, the virus that causes COVID-19. Measures should be implemented before patient arrival, upon arrival, throughout the duration of the patient’s visit, and until the patient’s room is cleaned and disinfected. It is particularly important to protect individuals at increased risk for adverse outcomes from COVID-19 (e.g. older individuals with comorbid conditions), including HCP who are in a recognized risk category.

• Before Arrival

o When scheduling appointments for routine medical care (e.g., annual physical, elective surgery), instruct patients to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat, fever1 ) on the day they are scheduled to be seen.

o When scheduling appointments for patients requesting evaluation for a respiratory infection, use nurse-directed triage protocols to determine if an appointment is necessary or if the patient can be managed from home.

▪ If the patient must come in for an appointment, instruct them to call beforehand to inform triage personnel that they have symptoms of a respiratory infection (e.g., cough, sore throat, fever1 ) and to take appropriate preventive actions (e.g., follow triage procedures, wear a facemask upon entry and throughout their visit or, if a facemask cannot be tolerated, use a tissue to contain respiratory secretions).

o If a patient is arriving via transport by emergency medical services (EMS), EMS personnel should contact the receiving emergency department (ED) or healthcare facility and follow previously agreed upon local or regional transport protocols. This will allow the healthcare facility to prepare for receipt of the patient.

• Upon Arrival and During the Visit

o Consider limiting points of entry to the facility.

o Take steps to ensure all persons with symptoms of COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette (see appendix), hand hygiene, and triage procedures throughout the duration of the visit.

▪ Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.

▪ Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

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▪ Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact between triage personnel and potentially infectious patients.

▪ Consider establishing triage stations outside the facility to screen patients before they enter.

o Ensure rapid safe triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough).

▪ Prioritize triage of patients with respiratory symptoms.

▪ Triage personnel should have a supply of facemasks and tissues for patients with symptoms of respiratory infection. These should be provided to patients with symptoms of respiratory infection at check-in. Source control (putting a facemask over the mouth and nose of a symptomatic patient) can help to prevent transmission to others.

▪ Ensure that, at the time of patient check-in, all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of COVID-19 or contact with possible COVID-19 patients.

▪ Isolate the patient in an examination room with the door closed. If an examination room is not readily available ensure the patient is not allowed to wait among other patients seeking care.

▪ Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies.

▪ In some settings, patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.

o Incorporate questions about new onset of respiratory symptoms into daily assessments of all admitted patients. Monitor for and evaluate all new fevers and respiratory illnesses among patients. Place any patient with unexplained fever or respiratory symptoms on appropriate Transmission-Based Precautions and evaluate.

Additional considerations during periods of community transmission:

o Explore alternatives to face-to-face triage and visits.

o Learn more about how healthcare facilities can Prepare for Community Transmission

o Designate an area at the facility (e.g., an ancillary building or temporary structure) or identify a location in the area to be a “respiratory virus evaluation center” where patients with fever or respiratory symptoms can seek evaluation and care.

o Cancel group healthcare activities (e.g., group therapy, recreational activities).

o Postpone elective procedures, surgeries, and non-urgent outpatient visits.

2. Adhere to Standard and Transmission-Based Precautions

Standard Precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the healthcare setting. Elements of Standard Precautions that apply to patients with respiratory infections, including COVID-19, are summarized below. Attention should be paid to training and proper donning (putting on), doffing (taking off), and disposal of any PPE. This document does not emphasize all aspects of Standard Precautions (e.g., injection safety) that are required for all

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patient care; the full description is provided in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

HCP (see Section 5 for measures for non-HCP visitors) who enter the room of a patient with known or suspected COVID-19 should adhere to Standard Precautions and use a respirator or facemask, gown, gloves, and eye protection. When available, respirators (instead of facemasks) are preferred; they should be prioritized for situations where respiratory protection is most important and the care of patients with pathogens requiring Airborne Precautions (e.g., tuberculosis, measles, varicella). Information about the recommended duration of Transmission-Based Precautions is available in the Interim Guidance for Discontinuation of Transmission-Based Precautions and Disposition of Hospitalized Patients with COVID-19

• Hand Hygiene

o HCP should perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that might have been transferred to bare hands during the removal process.

o HCP should perform hand hygiene by using ABHR with 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to ABHR.

o Healthcare facilities should ensure that hand hygiene supplies are readily available to all personnel in every care location.

• Personal Protective Equipment

Employers should select appropriate PPE and provide it to HCP in accordance with OSHA PPE standards (29 CFR 1910 Subpart I). HCP must receive training on and demonstrate an understanding of:

o when to use PPE

o what PPE is necessary o how to properly don, use, and doff PPE in a manner to prevent self-contamination

o how to properly dispose of or disinfect and maintain PPE o the limitations of PPE.

Any reusable PPE must be properly cleaned, decontaminated, and maintained after and between uses. Facilities should have policies and procedures describing a recommended sequence for safely donning and doffing PPE. The PPE recommended when caring for a patient with known or suspected COVID-19 includes:

o Respirator or Facemask

▪ Put on a respirator or facemask (if a respirator is not available) before entry into the patient room or care area.

▪ N95 respirators or respirators that offer a higher level of protection should be used instead of a facemask when performing or present for an aerosol-generating procedure (See Section 4). See appendix for respirator definition. Disposable respirators and facemasks should be removed and discarded after exiting the patient’s room or care area and closing the door. Perform hand hygiene after discarding the respirator or facemask. For guidance on extended use of respirators, refer to Strategies to Optimize the Current Supply of N95 Respirators

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▪ If reusable respirators (e.g., powered air purifying respirators [PAPRs]) are used, they must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.

▪ When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Those that do not currently have a respiratory protection program, but care for patients with pathogens for which a respirator is recommended, should implement a respiratory protection program.

o Eye Protection

▪ Put on eye protection (i.e., goggles or a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area. Personal eyeglasses and contact lenses are NOT considered adequate eye protection.

▪ Remove eye protection before leaving the patient room or care area.

▪ Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use. Disposable eye protection should be discarded after use.

o Gloves

▪ Put on clean, non-sterile gloves upon entry into the patient room or care area.

▪ Change gloves if they become torn or heavily contaminated.

▪ Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.

o Gowns

▪ Put on a clean isolation gown upon entry into the patient room or area. Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded after use. Cloth gowns should be laundered after each use.

▪ If there are shortages of gowns, they should be prioritized for:

▪ aerosol-generating procedures

▪ care activities where splashes and sprays are anticipated

▪ high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP. Examples include:

▪ dressing

▪ bathing/showering

▪ transferring

▪ providing hygiene

▪ changing linens

▪ changing briefs or assisting with toileting

▪ device care or use

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▪ wound care

3. Patient Placement

• For patients with COVID-19 or other respiratory infections, evaluate need for hospitalization. If hospitalization is not medically necessary, home care is preferable if the individual’s situation allows.

• If admitted, place a patient with known or suspected COVID-19 in a single-person room with the door closed. The patient should have a dedicated bathroom.

o Airborne Infection Isolation Rooms (AIIRs) (See definition of AIIR in appendix) should be reserved for patients who will be undergoing aerosol-generating procedures (See Aerosol Generating Procedures Section)

• As a measure to limit HCP exposure and conserve PPE, facilities could consider designating entire units within the facility, with dedicated HCP, to care for known or suspected COVID-19 patients. Dedicated means that HCP are assigned to care only for these patients during their shift.

o Determine how staffing needs will be met as the number of patients with known or suspected COVID-19 increases and HCP become ill and are excluded from work.

o It might not be possible to distinguish patients who have COVID-19 from patients with other respiratory viruses. As such, patients with different respiratory pathogens will likely be housed on the same unit. However, only patients with the same respiratory pathogen may be housed in the same room. For example, a patient with COVID-19 should not be housed in the same room as a patient with an undiagnosed respiratory infection.

o During times of limited access to respirators or facemasks, facilities could consider having HCP remove only gloves and gowns (if used) and perform hand hygiene between patients with the same diagnosis (e.g., confirmed COVID-19) while continuing to wear the same eye protection and respirator or facemask (i.e., extended use). Risk of transmission from eye protection and facemasks during extended use is expected to be very low.

▪ HCP must take care not to touch their eye protection and respirator or facemask.

▪ Eye protection and the respirator or facemask should be removed, and hand hygiene performed if they become damaged or soiled and when leaving the unit.

o HCP should strictly follow basic infection control practices between patients (e.g., hand hygiene, cleaning and disinfecting shared equipment).

• Limit transport and movement of the patient outside of the room to medically essential purposes.

o Consider providing portable x-ray equipment in patient cohort areas to reduce the need for patient transport.

• To the extent possible, patients with known or suspected COVID-19 should be housed in the same room for the duration of their stay in the facility (e.g., minimize room transfers).

• Patients should wear a facemask to contain secretions during transport. If patients cannot tolerate a facemask or one is not available, they should use tissues to cover their mouth and nose.

• Personnel entering the room should use PPE as described above.

• To the extent possible, patients with known or suspected COVID-19 should be housed in the same

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room for the duration of their stay in the facility (e.g., minimize room transfers).

• To the extent possible, patients with known or suspected COVID-19 should be housed in the same room for the duration of their stay in the facility (e.g., minimize room transfers).

• Whenever possible, perform procedures/tests in the patient’s room.

• Once the patient has been discharged or transferred, HCP, including environmental services personnel, should refrain from entering the vacated room until sufficient time has elapsed for enough air changes to remove potentially infectious particles (more information on clearance rates under differing ventilation conditions is available). After this time has elapsed, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use (See Section 10).

4. Take Precautions When Performing Aerosol-Generating Procedures (AGPs)

• Some procedures performed on patient with known or suspected COVID-19 could generate infectious aerosols. In particular, procedures that are likely to induce coughing (e.g., sputum induction, open suctioning of airways) should be performed cautiously and avoided if possible.

• If performed, the following should occur:

o HCP in the room should wear an N95 or higher-level respirator, eye protection, gloves, and a gown.

o The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for the procedure.

o AGPs should ideally take place in an AIIR.

o Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control below.

5. Collection of Diagnostic Respiratory Specimens

• When collecting diagnostic respiratory specimens (e.g., nasopharyngeal swab) from a possible COVID-19 patient, the following should occur:

o HCP in the room should wear an N-95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown.

o The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for specimen collection.

o Specimen collection should be performed in a normal examination room with the door closed.

o Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control below.

6. Manage Visitor Access and Movement Within the Facility

• Establish procedures for monitoring, managing and training all visitors, which should include:

o All visitors should perform frequent hand hygiene and follow respiratory hygiene and cough etiquette precautions while in the facility, especially common areas.

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o Passively screen visitors for symptoms of acute respiratory illness before entering the healthcare facility

▪ Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) advising visitors not to enter the facility when ill.

o Informing visitors about appropriate PPE use according to current facility visitor policy

o Visitors to the most vulnerable patients (e.g., oncology and transplant wards) should be limited; visitors should be screened for symptoms prior to entry to the unit.

• Limit visitors to patients with known or suspected COVID-19. Encourage use of alternative mechanisms for patient and visitor interactions such as video-call applications on cell phones or tablets. If visitation must occur, visits should be scheduled and controlled to allow for the following:

o Facilities should evaluate risk to the health of the visitor (e.g., visitor might have underlying illness putting them at higher risk for COVID-19) and ability to comply with precautions.

o Facilities should provide instruction, before visitors enter patients’ rooms, on hand hygiene, limiting surfaces touched, and use of PPE according to current facility policy while in the patient’s room.

o Visitors should not be present during AGPs or other specimen collection procedures.

o Visitors should be instructed to only visit the patient room. They should not go to other locations in the facility.

Additional considerations during periods of community transmission:

• All visitors should be actively assessed for fever and respiratory symptoms upon entry to the facility. If fever or respiratory symptoms are present, visitor should not be allowed entry into the facility.

• Determine the threshold at which screening of persons entering the facility will be initiated and at what point screening will escalate from passive (e.g., signs at the entrance) to active (e.g., direct questioning) to restricting all visitors to the facility.

• If restriction of all visitors is implemented, facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional well-being and care.

• Limit points of entry to the facility.

7. Implement Engineering Controls

• Design and install engineering controls to reduce or eliminate exposures by shielding HCP and other patients from infected individuals. Examples of engineering controls include:

o physical barriers or partitions to guide patients through triage areas

o curtains between patients in shared areas

o air-handling systems (with appropriate directionality, filtration, exchange rate, etc.) that are installed and properly maintained

8. Monitor and Manage Ill and Exposed Healthcare Personnel

• Facilities and organizations providing healthcare should implement sick leave policies for HCP that are non-punitive, flexible, and consistent with public health guidance.

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• Movement and monitoring decisions for HCP with exposure to COVID-19 should be made in consultation with public health authorities. Refer to the Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19) for additional information.

9. Train and Educate Healthcare Personnel

• Provide HCP with job- or task-specific education and training on preventing transmission of infectious agents, including refresher training.

• Ensure that HCP are educated, trained, and have practiced the appropriate use of PPE prior to caring for a patient, including attention to correct use of PPE and prevention of contamination of clothing, skin, and environment during the process of removing such equipment.

10. Implement Environmental Infection Control

• Dedicated medical equipment should be used when caring for patients with known or suspected COVID-19.

o All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.

• Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.

• Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARSCoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.

o Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.

• Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.

• Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control FAQs for COVID-19

11. Establish Reporting within and between Healthcare Facilities and to Public Health Authorities

• Implement mechanisms and policies that promote situational awareness for facility staff including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff about known or suspected COVID-19 patients and facility plans for response.

• Communicate and collaborate with public health authorities.

• Facilities should designate specific persons within the healthcare facility who are responsible for communication with public health officials and dissemination of information to HCP.

• Communicate information about known or suspected COVID-19 patients to appropriate personnel before transferring them to other departments in the facility (e.g., radiology) and to other healthcare facilities.

Appendix:

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Additional Information about Airborne Infection Isolation Rooms, Respirators and Facemasks Information about Airborne Infection Isolation Rooms (AIIRs):

• AIIRs are single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation).

• Air from these rooms should be exhausted directly to the outside or be filtered through a high efficiency particulate air (HEPA) filter directly before recirculation.

• Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.

• Facilities should monitor and document the proper negative-pressure function of these rooms.

Information about Respirators:

• A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in healthcare.

• Respirator use must be in the context of a complete respiratory protection program in accordance with OSHA Respiratory Protection standard (29 CFR 1910.134). HCP should be medically cleared and fit tested if using respirators with tight-fitting facepieces (e.g., a NIOSH-approved N95 respirator) and trained in the proper use of respirators, safe removal and disposal, and medical contraindications to respirator use.

• NIOSH information about respirators

• OSHA Respiratory Protection eTool

• Strategies for Optimizing the Supply of N-95 Respirators

Filtering Facepiece Respirators (FFR) including N95 Respirators

• A commonly used respirator in healthcare settings is a filtering facepiece respirator (commonly referred to as an N95). FFRs are disposable half facepiece respirators that filter out particles.

• To work properly, FFRs must be worn throughout the period of exposure and be specially fitted for each person who wears one. This is called “fit-testing” and is usually done in a workplace where respirators are used.

• Three key factors for an N95 respirator to be effective

• FFR users should also perform a user seal check to ensure proper fit each time an FFR is used. • Learn more about how to perform a user seal check

• For more information on how to perform a user seal check: https://www.cdc.gov/niosh/docs/2018- 130/pdfs/2018-130.pdf?id=10.26616/NIOSHPUB2018130

• NIOSH-approved N95 respirators list.

• PAPRs have a battery-powered blower that pulls air through attached filters, canisters, or cartridges. They provide protection against gases, vapors, or particles, when equipped with the appropriate cartridge, canister, or filter.

• Loose-fitting PAPRs do not require fit testing and can be used with facial hair.

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• A list of NIOSH-approved PAPRs is located on the NIOSH Certified Equipment List. Information about

Facemasks:

• If worn properly, a facemask helps block respiratory secretions produced by the wearer from contaminating other persons and surfaces (often called source control).

• Facemasks are cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. Facemasks should be used once and then thrown away in the trash.

Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for COVID-19 CDC has developed interim guidance for staff at local and state health departments, infection prevention and control professionals, healthcare providers, and healthcare workers who are coordinating the home care and isolation of people who are confirmed to have, or being evaluated for (COVID-19 (see Criteria to Guide Evaluation of Patients Under Investigation (PUI) for COVID-19).

Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization forCOVID-19)

Important Links

• Respirator Trusted-Source Information

• Respirator Fact Sheet

Footnote 1Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain medications. Clinical judgement should be used to guide testing of patients in such situations.

Categories of Health Alert messages:

Health Alert: conveys the highest level of importance; warrants immediate action or attention.

Health Advisory: provides important information for a specific incident or situation; may not require immediate action.

Health Update: provides updated information regarding an incident or situation; unlikely to require immediate action.

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Cleaning Tips for COVID-19

ISSA Tip Sheet

February 18, 2020

Recommendations for USING DISINFECTANTS for the Cleaning and Forensic Restoration Industry in Response to SARS-CoV-2 (COVID-19)

In the Unites States, on January 29, 2020, the Environmental Protection Agency (EPA) activated the Emerging Viral Pathogen Guidance for Antimicrobial Pesticides (Guidance) in response to the discovery of the novel coronavirus, SARS-CoV-2. The EPA’s emerging pathogens guidance is only triggered after the U.S. Centers for Disease Control and Prevention (CDC) “has identified the emerging pathogen and recommended environmental surface disinfection to help control its spread.” EPA implements the policy in close coordination with the CDC and reportedly the two agencies are closely monitoring developments with the coronavirus.

The guidance, issued in 2016, details a process by which companies holding current EPA registrations under the Federal Insecticide Fungicide and Rodenticide Act (FIFRA) for certain disinfectant products can promote those products for use against “emerging pathogens,” like the coronavirus.

Typically, to be registered for use against a specific bacteria or virus, disinfecting/antimicrobial products must submit to EPA test data showing that the product is effective against that particular microbe. EPA’s “emerging pathogens” policy was established to allow for the legal “off-label” use of disinfectants against a novel virus for which no product would as yet have EPA approval and for which test data and methods likely do not exist.

“Many of the emerging pathogens of greatest concern are pathogenic viruses, and the ability of some of these viruses to persist on environmental surfaces can play a role in human disease transmission.” – EPA Office of Pesticide Programs, “Update: Coronavirus Cases Trigger EPA Rapid Response” (Jan. 29, 2020)

The guidance establishes a two-step process.

• First, registrants submit a request to EPA for a label amendment adding to their registration a statement of effectiveness against emerging viral pathogens. This may (and, ideally, should) be done prior to an outbreak. If the product meets the eligibility criteria, detailed in the guidance document, the agency generally will approve the amendment.

• The second stage of the process, when an outbreak of an emerging pathogen occurs, such as what we are seeing with the novel coronavirus, SARS-CoV-2, registrants of products with the “emerging pathogen” label amendment may then communicate to the health care community and public that their product may be used against the newly emerged pathogen.

Registrants work closely with the EPA to ensure that they are following the guidance and avoid potential citations.

Registrants with a “pre-qualified emerging viral pathogen designation” can include a statement regarding efficacy against an emerging pathogen “in technical literature distributed to health care facilities, physicians, nurses, public health officials, non-label-related websites, consumer information services, and social media sites.”

If you have questions about your favorite disinfectant, refer to the manufacturer’s website to see if it has the emerging pathogens claim for the novel coronavirus, SARS-CoV-2.

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But what about for the rest of the world? Each country will have their own requirement for disinfectant claims for SARS-CoV-2. It is important to review the requirements and approvals in your country.

Refer to ISSA/GBAC Tip Sheet 2 - Recommendations for RISK ASSESSMENT for the Cleaning and Forensic Restoration Industry, when preparing to clean, sanitize, and disinfect spaces.

Below are links to sites with more information on SARS-CoV-2, including, ISSA, WHO, CDC, EPA, and www.InfectionControl.tips:

• https://www.issa.com/education/cleaning-for-infection-prevention/coronavirus-prevention-andcontrol-for-the-cleaning-industry

• https://www.kelleygreenlawblog.com/2020/01/coronavirus-activates-epa-emerging-pathogens-rapidresponse/(source material)

• https://www.cdc.gov/coronavirus/index.html

• https://www.epa.gov/pesticide-registration/emerging-viral-pathogen-guidance-antimicrobialpesticides

• https://infectioncontrol.tips/

Previous Tip Sheets:

View the GBAC Tip Sheet on using personal protective equipment here.

View the GBAC Tip Sheet on risk assessment here.

Other links of interest:

• Coronavirus: Prevention and Control for the Cleaning Industry

• U.S. Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Situation Summary

• World Health Organization (WHO) Novel Coronavirus Coverage

VISIT THE GBAC TRAINING AND EVENTS PAGE

Approved Disinfectants for Use Against SARS-CoV-2: Guidance from EPA:

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

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Oklahoma State Department of Health (OSDH) Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Assisted Living, Residental Care, and Adult Care Centers

(3/18/20)

The Oklahoma State Department of Health (OSDH) is releasing the following updates based on guidance released by the Centers for Disease Control and Prevention (CDC) on March 10, 2020, for infection prevention and control recommendations for patients with suspected or confirmed COVID-19 in healthcare settings.

GENERAL GUIDANCE

You may call Long Term Care during normal business hours at 405-271-6868 or 1-800-747-8419 to consult with a surveyor on best practices for infection control and employee screening. You may also call the OSDH Coronavirus Hotline is open 24 hours a day: 866-462-3821. Facilities should contact their health care provider first if they have clinical questions or suspect a resident in one of these settings to have COVID-19. Prompt detection, triage and isolation of residents/clients potentially infected with COVID-19 are essential to prevent unnecessary exposures among residents, facility staff, and visitors.

Facilities experiencing an increased number of respiratory illnesses (regardless of suspected etiology) among residents or staff should immediately contact their local health department for further guidance.

In addition to the overarching regulations and guidance, we’re providing the following information (Frequently Asked Questions) about some specific areas related to COVID-19:

GUIDANCE FOR LIMITING THE TRANSMISSION OF COVID-19 FOR ASSISTED LIVING, RESIDENTIAL CARE, AND ADULT CARE CENTERS

What can an Assisted Living, Residential Care, and Adult Care Center do to be prepared?

• Review your infection control policies and procedures.

• Assess your infection control supplies (regular surgical mask, gloves, gown, eye protection, cleaning and disinfecting solutions) which are all applicable to preventing the spread of illnesses such as influenza, COVID-19, and norovirus. See CDC guidance Strategies for Optimizing the Supply of Personal Protective Equipment .

• Review Infection Control Training courses with facility staff. Training may be located at: https://www.cdc.gov/infectioncontrol/; suggested training is the Nursing Home Infection Preventionist Training course and may be found at: www.cdc.gov/longtermcare/training.html

• Post the telephone number to your local health department in a place visible to staff. County HD information is here: https://chds.health.ok.gov

• Communicate proactively with staff about monitoring and reporting their own and resident symptoms. Provide guidance on when to stay home, and when to return to work.

• Remind staff and residents and post signage throughout the facility on some practical things we can all do to prevent the spread of any respiratory illness, such as cold or flu:

1. Wash your hands often with soap and water for at least 20 seconds. Use of an alcohol-based hand rub with at least 60% alcohol can be used if hands are not visibly soiled.

2. Avoid close contact with people who are sick.

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3. Avoid touching your eyes, nose, and mouth.

4. Stay home when you are sick.

5. Cover your cough or sneeze with a tissue, then throw it away.

6. Clean and disinfect frequently touched objects and surfaces using regular household cleaning spray.

• Cancel or restrict communal dining and all group activities. A key reason for this recommendation is linked to the concept of social distancing (e.g., limiting people being in close proximity to each other for periods of time; ideally people should keep about six [6] feet apart). For those residents or participants that must be supervised at mealtime; consider staggered meal service so that greater separation can be obtained.

How should facilities limit visitors?

Visitors are discouraged and may be restricted or denied. Communicate to families the danger that this virus presents to their loved one. Pursuant to Governor Stitt’s Executive Order 2020-06 and President Trump’s declaration of a National Public Health Emergency, the Oklahoma State Department of Health is authorizing Assisted Living, Residential Care, and Adult Care Centers to restrict visitors as they deem necessary to protect those they serve.

Visitors with signs and symptoms of a transmissible infection (e.g., a visitor has a fever (100.4) and are exhibiting signs and symptoms of a flu-like illness) should be refused entry until no longer potentially infectious (e.g., 24 hours after resolution of fever without medication).

Law enforcement should be notified when visitors access the property without authorization. Signage must be clearly posted.

Facilities should screen anyone entering the facility for the following:

1) Travel from an affected geographic area within the last 14 days. For updated information on affected geographic areas, visit https://coronavirus.health.ok.gov/ and https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html/

2) Signs or symptoms of a respiratory infection, such as a fever, cough, and sore throat.

3) Has had contact with someone laboratory-confirmed for COVID-19.

Specifically, a facility may restrict or limit visitation rights for reasonable clinical and safety reasons. A resident’s risk factors for infection (e.g., immunocompromised condition) or current health state (e.g., end-of-life care) should be considered when restricting visitors.

How should facilities monitor or restrict facility staff?

The same screening performed for visitors should be performed for facility staff (numbers 1, 2, and 3 above). As COVID-19 spreads, more and more staff will live in affected cities. Therefore, the daily temperature screenings will be critical.

• Implement sick leave policies that are non-punitive, flexible, and consistent with public health policies that allow ill HCP to stay home.

• As part of routine practice, ask health care personnel (HCP) (including consultant personnel) to

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regularly monitor themselves for fever and symptoms of respiratory infection.

• Facility staff who have signs and symptoms of a respiratory infection should not report to work.

• Restrict nonessential healthcare personnel (including consultant personnel) and volunteers for entering the building.

• Screen all HCP at the beginning of their shift for fever and respiratory symptoms.

o Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat.

o If the HCP is ill, have them put on a facemask, notify their supervisor, leave the workplace, and self-isolate at home.

o Report to the local health department individuals, equipment, and locations the affected person came in contact with, and follow the recommendations for next steps (e.g., testing, locations for treatment). o Consult occupational health on decisions about further evaluation and return to work

• HCP who work in multiple locations may pose higher risk and should be asked about exposure to facilities with recognized COVID-19 cases.

• When transmission in the community is identified, assisted living facilities, residential care, and Adult Care Centers may face staffing shortages. Facilities should develop (or review existing) plans to mitigate staffing shortages.

• Refer to your local health department and the following CDC guidance for exposures that might warrant restricting asymptomatic facility staff from reporting to work: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html.

When should an Assisted Living, Residential Care, and Adult Care Center consider transferring a resident with suspected or confirmed infection with COVID-19 to a hospital?

Facilities should contact their or the residents health care provider initially and then local health department. Residents infected with COVID-19 may vary in severity from lack of symptoms to mild or severe symptoms. Initially, symptoms may be mild and not require transfer to a hospital as long as the facility can follow the infection prevention and control practices recommended by CDC and the local health department. (https://www.cdc.gov/coronavirus/2019-ncov/infection-control/index.html)

The resident may develop more severe symptoms and require transfer to a hospital for a higher level of care. Prior to transfer, emergency medical services and the receiving facility should be alerted to the resident’s diagnosis, and precautions to be taken including placing a facemask on the resident during transfer. Pending transfer, place a facemask on the patient and isolate him/her in a room with the door closed.

If a family is going against the recommended guidance and advice and takes the resident out into the community for a day trip, and then wants to bring them back, what should the facility do?

• Residents leaving and returning to the facility are discouraged. Seniors with multiple health conditions are at highest risk for serious complications from COVID-19.

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• Facilities should consider policies that prohibit residents from leaving and returning to the facility during the period of the national emergency declaration. In the alternative, facilities should consider policies that require that any resident returning from an outing is subject to a 14 day quarantine in their room.

When should an Assisted Living, Residential Care, and Adult Care Center accept a resident who was diagnosed with COVID-19 from a hospital?

Facilities may accept a resident diagnosed with COVID-19 and still under Transmission- based Precautions for COVID-19 as long as it can follow CDC and local health department guidance for transmission-based precautions. If the facility is unable to follow the recommended guidelines, it must wait until these precautions are discontinued. These decisions should be made on a case-by-case basis in consultation with the resident’s clinicians, infection prevention and control specialists, and public health officials.

Note: Facilities may admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was/is present.

OTHER CONSIDERATIONS FOR FACILITIES:

• Review CDC guidance for Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019: https://www.cdc.gov/coronavirus/2019-ncov/infectioncontrol/control-recommendations.html

• Frequently review information and guidance on the OSDH COVID-19 website at https://coronavirus.health.ok.gov/

• Increase the availability and accessibility of alcohol-based hand sanitizer (ABHS), tissues, no-touch receptacles for disposal, and facemasks at facility entrances, common areas, etc.

• Ensure ABHS is accessible in all resident-care areas including inside and outside resident rooms.

• Increase signage for vigilant infection prevention, such as hand hygiene and cough etiquette.

• Properly clean, disinfect and limit sharing of medical equipment between residents and areas of the facility.

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• Provide additional work supplies for staff to avoid sharing (e.g., pens, pads) and disinfect workplace areas frequently (nurse’s stations, phones, internal radios, etc.). 1 https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html 2 https://paltc.org/COVID-19

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station and be ready to share with OSDH.Incident Commander; post contact information in nursing Activate your incident command structure and identify an

PLAN

needs to your healthcare coalition. environmental cleaning products. Report immediate Assess current supply of PPE, hand hygiene products, and

ASSESS

.2the guidance for Active ScreeningBegin active screening of all residents every 8 hours. Use SCREEN

similar tool, to track symptomatic residents and staff. , or 2Use the COVID-19 Symptomatic Line List TemplateTRACK

taking inquiry calls. . Identify a person who will be 2A sample letter is available

Communicate to all staff, residents and family members. INFORM

department or call 1-877-215-8336. your local health andContact your regulatory agency NOTIFY

Restrict all residents to their room. No visitation. CONTAIN

1CDC.as per contingency capacity strategies implementsupply is limited, wear facemasks for routine care and

. If respirator for all resident careN95 or higher respirator and an goggles or face shieldar gown, gloves, Ideally, we

PROTECT

a private room and keep the door closed. a private bathroom if available. If one isn’t available, use Place positive resident in an airborne isolation room with

ISOLATE

same and to not spread fear or confidential information. Take a deep breath and stay calm; remind staff to do the BREATHE

Facilities with a confirmed Case of COVID-19 for Long-term Care TEN INITIAL STEPS

SAMPLE TEMPLATE: COMMUNICATION TO EMPLOYEES

Subject: [COMMUNITY] Coronavirus Response Update

[COMMUNITY] wants to assure you that we are well prepared to respond should the coronavirus COVID-19 reach our region. [A Coronavirus Task Force comprised of staff from various departments] met yesterday to review existing policies and procedures related to infectious diseases and to plan for other concerns if the virus reaches our region or campus. Our existing infection control policies and procedures will guide us as we work to prevent the spread of infection and control it as necessary.

Here are some things you can do to help us be prepared:

1. Effective immediately, please report any travel plans outside [REGION] for you or your family to your manager so that they can pass this information on to Human Resources. We are asking residents to do the same so we can monitor people who have travelled to affected areas. Please share where you are going, when you are leaving and when you plan to return.

2. Follow these five recommendations from the World Health Organization to help prevent the spread of flu, COVID-19 and other viruses:

Wash your hands frequently with soap and water, or if your hands are not visibly dirty, use an alcohol-based hand rub.

Cover your mouth and nose with a flexed elbow or tissue when coughing and sneezing

If possible, keep a distance of around three feet between yourself and someone who is coughing, sneezing or has a fever.

Avoid touching your eyes, nose and mouth.

If you have a fever, cough AND difficulty breathing, seek medical care. Phone ahead to your doctor’s office and seek medical attention. Do not come to work until cleared by your hysician.

3. Stay informed and prepared at home. You can refer to NPR’s Life Kit, A Guide: How to Prepare Your Home for Coronavirus

At this time, we are calmly focused on preparedness and prevention. As the situation changes, there may be additional training and other ways we will ask you to help. More information will be shared regularly via email, our staff Facebook page and more. If you have questions, please talk to your manager.

For more general information:

LeadingAge-Coronavirus Resourcess

World Health Organization-Coronavirus

Centers for Disease Control-Coronavirus

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SAMPLE TEMPLATE: MEMO TO RESIDENTS

TO: All Residents

FROM: [ADMINISTRATOR NAME], [TITLE]

SUBJECT: Coronavirus Preparedness and Response

DATE: [DATE]

[COMMUNITY] wants to assure you that we are well prepared to respond should the coronavirus COVID-19 reach our region. [A Coronavirus Task Force comprised of staff from various departments] met yesterday to review existing policies and procedures related to infectious diseases and to plan for other concerns if the virus reaches our region or campus. Our existing infection control policies and procedures will guide us as we work to prevent the spread of infection and control it as necessary.

Here are some things you can do to help us be prepared:

1. Effective immediately, please report your travel plans outside [REGION] for you or your family to the appropriate person for your area of living:

[NAME] – [CONTACT INFO]

[NAME] – [CONTACT INFO]

[NAME] – [CONTACT INFO]

We are asking our employees to do the same so we can monitor people who have travelled to affected areas. Please share where you are going, when you are leaving and when you plan to return.

2. Follow these five recommendations from the World Health Organization to help prevent the spread of flu, COVID-19 and other viruses:

Wash your hands frequently with soap and water, or if your hands are not visibly dirty, use an alcohol-based hand rub.

Cover your mouth and nose with a flexed elbow or tissue when coughing and sneezing

If possible, keep a distance of around three feet between yourself and someone who is coughing, sneezing or has a fever.

Avoid touching your eyes, nose and mouth.

If you have a fever, cough AND difficulty breathing, seek medical care. Phone ahead to your primary care physician or the Clinic.

At this time, we are calmly focused on preparedness and prevention. As the situation changes, we will keep you up to date on steps we are taking and how you can help. More information will be shared regularly via email. If you have questions, please contact [COMMUNITY] at [PHONE OR EMAIL].

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SAMPLE TEMPLATE: LETTER TO FAMILIES FOLLOWING POSITIVE DIAGNOSIS (DHS)

DATE

Dear Friends and Family of [Community]:

As our nation, Oklahoma, and local communities deal with the coronavirus pandemic, we want to provide you with an update on how it has impacted our community and the steps we’re taking to address it.

[resident update] We have felt the virus’s direct effects here at [Community]. We currently have ___ COVID-19 cases, which are located in ______________. When a resident tests positive for COVID-19, we take great care to ensure they are made comfortable in an isolated setting and are under constant supervision. While caring for residents in isolation, staff wear full protective equipment, including medical gowns, gloves, eye protection and masks, and are restricted to working solely in their units.

[staff update] ____ staff members working in our _________ division have tested positive and are quarantined at home. We are currently following the “Criteria for Return to Work for Health Care Personnel with Confirmed or Suspected COVID-19” guidance issued by the Centers for Disease Control and Prevention (CDC). We have contacted all people who have come into contact with these employees, and as a result, ___ more people are being tested.

As the number of overall cases in our country and Oklahoma increase exponentially, we expect there will be additional cases at our facility because this disease especially impacts people who live in communal settings.

Please know that we have followed and will continue follow all guidance set forth for privacy, patient care, employee safety, and efforts to stop the spread of COVID-19 as provided by the Oklahoma State Department of Health (OSDH) and the federal Centers for Medicare and Medicaid Services (CMS).

While we strive for transparency in everything we do, please know that we are bound by federal guidelines under the Health Insurance Portability and Accountability Act (HIPAA), which protect the privacy of our residents, who may not want their condition known. Our medical director follows all established federal laws in notifying families of any change in the medical condition of their loved ones. Our residents are our first priority.

Prior to each shift, staff are required to wash their hands, take their temperature and answer a series of questions to ensure they are not exhibiting any known COVID-19 symptoms. Employees also take their temperatures at the conclusion of their shift. Any employees who develop symptoms during a shift are immediately sent home. At that point, they are directed to quarantine at home. This process is also followed for outside vendors and agency workers, though these visits have been curtailed.

We also conduct a rigorous sanitation regimen that follows, and in some cases exceeds, all state and federal guidelines. We have increased the daily volume of cleaning in common, medical and residential areas. All protective and medical equipment are thoroughly cleaned and disinfected.

Although this can be a challenge when providing medical care, our facility continues to practice safe distancing guidelines by limiting the number of people in one area and maintaining 6 feet of separation. Doors are shut in common areas to discourage group gatherings. Our restaurant is now closed for dining, but meals are available for pickup or delivery to residents and staff.

[Community] appreciates your understanding as we continue to vigorously enforce Oklahoma’s decision to restrict all visits into the facility at this time. This is certainly frustrating when wanting to see loved

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ones, but we want to do everything in our power to keep our residents healthy. We continue to encourage family members to communicate regularly through FaceTime or Skype calls, phone calls, and emails. For more information on scheduling virtual visitation, please contact a member of our activities departments at _______ [number] for residents in health care or personal care, and _________ [number] for residents living independently in apartments or cottages.

We will continue to provide you with periodic updates with as much information as we can on our efforts to combat COVID-19. On behalf of the entire [Community], I want to thank each of you for your continued patience and prayers. It means a great deal to us.

Sincerely,

[Community] Administration

SAMPLE TEMPLATE: GENERAL FACEBOOK ANNOUNCEMENT

The news is full of stories about coronavirus or COVID-19. [COMMUNITY] wants to assure you that we are proactively preparing should the coronavirus COVID-19 reach our region. In the meantime, you can help limit the spread by following these steps from the World Health Organization. If you’re sick, please stay home, rest up and plan to visit us when you’re all better.

SAMPLE TEMPLATE: PRESS RELEASE OF POSITIVE DIAGNOSIS

INSERT ORGANIZATION’S LOGO HERE

[Insert Organization Name] Statement on COVID-19 Diagnosis

Contact: [insert name]

[insert email] [insert phone number]

[insert day, month, year] [insert location] -- A case of COVID-19, the illness resulting from the novel coronavirus, has been diagnosed in a [insert: resident/employee/etc] of [insert organization].

“The [resident/client we serve/staff member] is in [what: quarantine at home/in the hospital]. We have notified public health officials as required and are following procedures recommended by the Centers for Disease Control & Prevention,” said [insert name and title]. “We are taking every step as recommended by authorities to contain the spread. We want to make residents, their families, our dedicated staff, and our community aware of this situation and reassure everyone that we are on top of the situation.”

About [insert organization name]: A [insert care setting/provider type here] serving the community of [insert locale/town/region] since [insert date], [insert organization name] employees [insert number of staffers] caring for a community of [insert number] of residents. [add mission]. For more information, visit [insert website].

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SAMPLE TEMPLATE: PRESS RELEASE OF POSITIVE DIAGNOSIS (2)

[FACILITY NAME] confirms first employee COVID-19 Case

[LOCATION]- [Facility name] announced today that an employee has tested positive for COVID-19. The test was confirmed by the Oklahoma State Department of Health (OSDH) last evening (DATE). The individual went home as soon as symptoms were recognized, and has been at home since that time

The employee is following treatment according to protocols and procedures regarding COVID-19. OSDH is in close contact with the Centers for Disease Control and Prevention (CDC).

[Facility Name] notified a small number of patients who may have interacted with the staff member, recommending they self-quarantine and monitor themselves for symptoms. We will continue to evaluate whether these patients should be screened or tested for COVID-19 and whether further action is required.

The employee’s coworkers have also been notified of their possible exposure, and employees are wearing masks around other people on campus, checking temperatures twice per day, and monitoring for symptoms.

Due to federal privacy laws, and out of respect for the privacy of our employee and the family, [Facility Name] is not sharing any additional information about the medical status of the employee.

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Media Talking Points

Tailor these as needed to your setting:

RESIDENTS’ WELL-BEING IS TOP PRIORITY: The health and well-being of our residents is our top priority.

WE ARE CONCERNED AND PROACTIVE: We are concerned about the spread of the novel coronavirus. The people we serve are typically more vulnerable to the virus and the disease it causes, COVID-19. We are taking action

OUR FOCUS IS ON INFECTION PREVENTION AND CONTROL:

● We have emergency preparedness and infection prevention and control plans in place. These provide detailed instructions for staff on how we address and manage infectious disease outbreaks.

● Our staff is trained in infection control practices and follows established protocols based on that training. We have experience managing illness outbreaks, such as flu, and have a heightened awareness of the possible risk to our residents posed by viral illnesses, such as flu, norovirus, and COVID-19.

● We have implemented daily cleaning processes at our community that are part of the emergency plan.

WE ARE INFORMED: Because the coronavirus is spreading quickly, our staff is in communication with public health officials [insert other organizations as appropriate] in our region to stay abreast of the latest developments about coronavirus. In addition, we are closely monitoring information from the [insert state department of health name] as well as those from federal agencies, such as the Centers for Disease Control and Prevention, [CMS, if applicable] and the World Health Organization.

WE ARE EDUCATING: As we learn more about coronavirus and COVID-19, the disease caused by the virus, we are educating staff, residents, and families. Current protocols we’ve implemented include:

● For staff: teaching them about the symptoms of COVID-19 and monitoring residents for these symptoms; teaching staff about how the virus spreads and recommended containment actions, including staying home from work if they are symptomatic.

● For residents and families: how to recognize symptoms of COVID-19 and what to do if they suspect that they or a loved one may be infected.

● For everyone: because older adults can be vulnerable to the spread of viral illnesses, including coronavirus, we are asking that everyone who comes in contact with our community members to be particularly vigilant and follow recommended guidance on prevention. Specifically:

○ Washing hands regularly and sufficiently.

○ Cleaning and wiping down frequently touched surfaces.

○ Limiting contact with others (social distancing).

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○ Staying at home if they are feeling ill.

WE ARE AVAILABLE: A fast-changing, potential crisis situation such as this calls for consistent communication. We are committed to providing you with information, updated regularly. You can [insert your communication channel here] for the latest from our community leaders.

￭Examples from LeadingAge members:

○Life plan community: https://www.actsretirement.org/statement-on-coronavirus/

○Skilled nursing provider: https://www.agrhodes.org/coronavirus/

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Sample COVID-19 Infection Control Policy

[INSERT LOGO]

Infection Control COVID-19

Policy Statement

[facility name’s] Infection Control Program (ICP), includes policies and procedures to assist in preventing transmission of COVID-19 into the [facility name] campus. In the event a transmission occurs, prompt detection and effective triage and isolation of potentially infectious residents are essential to prevent unnecessary exposures among additional residents, employees, and visitors.

[facility name] recognizes its high-risk population and, as such, the actions listed below will be implemented, and [facility name] will further coordinate the ICP and Emergency Preparedness (EP) plans to address COVID-19. These policies and practices are based on Infection Prevention and Control recommendations from the Centers for Disease Control (CDC), Oklahoma State Department of Health (OSDH) and the World Health Organization (WHO) and is based on the currently limited information available about coronavirus disease 2019 (COVID-19) related to disease severity, transmission efficiency, and shedding duration. According to the CDC, their guidance is applicable to all U.S. healthcare settings and subject to change as more information becomes available. [facility name] will monitor the CDC website routinely and update this policy as needed.

Background

Coronavirus disease 2019 (COVID-19) is a respiratory disease first detected in China. Early on, many of the patients in the epicenter of the outbreak in Wuhan, Hubei Province, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Person-to-person spread was subsequently reported outside of Hubei and in countries outside China, including the United States (US). To date, imported, person-to-person, and community spread cases have been identified in the US.

Community spread means some people have been infected and it is not known how or where they became exposed. The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”). Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with fever, cough, and difficulty breathing. It has also been determined older adults and individuals with severe chronic medical conditions, such as heart, lung or kidney disease, are higher risk for more serious COVID-19 (Control, 2020).

Early reports suggest person-to-person transmission most commonly happens during close exposure to a person infected with COVID-19, primarily via respiratory droplets produced when the infected person coughs or sneezes. Droplets can land in the mouths, noses, or eyes of people who are nearby or possibly be inhaled into the lungs of those within close proximity. The contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. However, airborne transmission from person-to-person over long distances is unlikely.

Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas.

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Definitions

Airborne precautions refer to actions taken to prevent or minimize the transmission of infections agents/organisms that remain infections over long distances when suspended in the air. These particles can remain suspended in the air for prolonged periods of time and can be carried on normal air currents in a room or beyond, to adjacent spaces or areas receiving exhaust air.

Close contact for healthcare exposures is defined as follows: a) being within approximately 6 feet (2 meters), of a person with COVID-19 for a prolonged period of time (such as caring for or visiting the resident; or sitting within 6 feet of the resident in a healthcare common area or room); or b) having unprotected direct contact with infectious secretions or excretions of the resident (e.g., being coughed on, touching used tissues with a bare hand).

Cohorting is the practice of grouping residents infected with the same infectious agent together to confine their care to one area and prevent contact with susceptible residents. During outbreaks, healthcare staff may be assigned to a specific cohort of residents to further limit opportunities for transmission.

Droplet precautions refer to actions designed to reduce/prevent the transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions.

Healthcare Personnel (HCP): For the purposes of this document HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to residents or infectious materials, including body substances; contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air.

Isolation means the separation of a person or group of people known or reasonably believed to be infected with a communicable disease and potentially infectious from those who are not infected to prevent spread of the communicable disease.

Personal protective equipment (PPE) are protective items or garments worn to protect the body or clothing from hazards that can cause injury and to protect residents from cross-transmission. This includes but is not limited to gloves, gowns, goggles, facemasks, or respirators.

Standard precautions are infection prevention practices that apply to all residents, regardless of suspected or confirmed diagnosis or presumed infection status. Standard precautions are based on the principle that all blood, body fluids, secretions, excretions except sweat, regardless of whether they contain visible blood, non-intact skin, and mucous membranes may contain transmissible infections agents.

Transmission based precautions are the second tier of basic infection control and are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection transmission.

Defining HCP Exposure Risk Categories and Appropriate PPE

While body fluids other than respiratory secretions have not been clearly implicated in transmission of COVID-19, unprotected contact with other body fluids, including blood, stool, vomit, and urine, might put HCP at risk of COVID-19.

According to CDC guidance, high-risk exposures refer to HCP who performed or were present in the room for treatments or procedures that generate aerosols or during which respiratory secretions are likely to be poorly controlled (e.g., cardiopulmonary resuscitation, nebulizer therapy, sputum induction) on residents with COVID-19 when the healthcare providers’ eyes, nose, or mouth were not protected.

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When high-risk treatments or procedures are completed by a [facility name] staff member, the following PPE will be required: gloves, gown, goggles and respirator. While a respirator is preferred in high-risk exposure situations, and respirators should be prioritized for high-risk treatments and procedures that are likely to generate respiratory aerosols, a facemask is an acceptable alternative and may be used in the event respirator supply is unavailable.

Medium-risk exposures generally include HCP who had prolonged close contact with residents with COVID-19 where HCP mucous membranes were exposed to material potentially infectious with the virus causing COVID-19. These scenarios involve interactions with symptomatic residents who were not wearing a facemask for source control. Because these exposures do not involve treatments or procedures that generate aerosols, they pose less than that described under high-risk. When a [facility name] staff member is involved in medium-risk exposure situations, the following PPE will be required: gloves, gown, goggles and respirator. While a respirator is preferred in medium-risk exposure situations, if a respirator is not available, a facemask may be used.

Low-risk exposures generally refer to brief interactions with residents with COVID-19 or prolonged close contact with residents who were wearing a facemask for source control while HCP were wearing a facemask or respirator. Use of eye protection, in addition to a facemask or respirator would further lower the risk of exposure. When a [facility name] staff member is involved in low-risk exposure situations, the following PPE will be required: gloves, gown, goggles and facemask.

Proper adherence to currently recommended infection control practices, including all recommended PPE, should protect HCP having prolonged close contact with residents infected with COVID-19. However, to account for any inconsistencies in use or adherence that could result in unrecognized exposures HCP should still perform self-monitoring with delegated supervision.

HCP with no direct resident contact and no entry into active resident management areas who adhere to routine safety precautions do not have a risk of exposure to COVID-19 (i.e., they have no identifiable risk.)

Preventing the Introduction of COVID-19 into our Campus

I. The primary goal of [facility name] is to prevent COVID-19 from being introduced within our campus. Prevention efforts include:

a. Following Standard Precautions, which are the minimum infection prevention practices that apply to all resident care, regardless of suspected or confirmed infection status of the resident, in any setting where health care is delivered. These practices are designed to both protect HCP; and prevent HCP from spreading infections among residents. Standard Precautions include —

i. Hand hygiene - washing hands often with soap and water for at least 20 seconds or using an alcohol-based hand rub that contains at least 60% alcohol before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. - Hand hygiene after removing PPE is particularly important to remove

any pathogens that might have been transferred to bare hands during the removal process.

- If hands are visibly soiled, staff will use soap and water before returning to alcohol-based hand rub.

ii. Use of personal protective equipment (e.g., gloves, gowns, masks, eyewear) when there is an expectation of possible exposure to infectious material.

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iii. Respiratory hygiene/cough etiquette principles.iv. Properly handle and properly clean and disinfect patient care equipment and

instruments/devices. v. Clean and disinfect the environment appropriately; and in accordance with

[facility name’s] environmental services policy.vi. Handle textiles and laundry carefully; and in accordance with [facility name’s]

linen handling policy.b. Providing training and education for staff, residents, and visitors on COVID-19 to include

prevalence, signs and symptoms, standard precautions, and the [facility name] Infection Control and Emergency Preparedness plans. Additionally, on:

i. Avoiding touching eyes, nose, and mouth with unwashed hands.

ii. Avoiding close contact with people who are sick; and

iii. Maintaining social distances, when possible, of 6 feet or greater.

c. Following CMS' recommendations for restricting visitors.

d. Reminding employees to stay home if they are experiencing fever and respiratory symptoms.

e. Ongoing communication with residents, employees, and resident representatives/families.

f. Monitoring residents (current and new admissions) and employees for fever or respiratory symptoms, such as, cough, or shortness of breath.

i. If symptoms are identified, move to action steps to prevent the spread of respiratory germs within the [facility name] campus to include restricting residents with fever or acute respiratory symptoms to their room. If they must leave the room for medically necessary procedures, have them wear a facemask, if tolerated.

Preventing the Spread of COVID-19 Within our Campus

II. In the event COVID-19 is introduced within the [facility name] campus, our efforts will transition to preventing the COVID-19 from spreading. Prevention efforts will include:

a. Following Standard Precautions for all residents, which are the minimum infection prevention practices that apply to all resident care, regardless of suspected or confirmed infection status of the resident, in any setting where health care is delivered. These practices are designed to both protect HCP and prevent HCP from spreading infections among residents. Standard Precautions include —

i. Hand hygiene - washing hands often with soap and water for at least 20 seconds or using an alcohol-based hand rub that contains at least 60% alcohol before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. - Hand hygiene after removing PPE is particularly important to remove

any pathogens that might have been transferred to bare hands during the removal process.

- If hands are visibly soiled, staff will use soap and water before returning to alcohol-based hand rub.

ii. Use of personal protective equipment (e.g., gloves, gowns, masks, eyewear)

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when there is an expectation of possible exposure to infectious material.iii. Respiratory hygiene/cough etiquette principles.iv. Properly handle and properly clean and disinfect patient care equipment and

instruments/devices. v. Clean and disinfect the environment appropriately; and in accordance with

[facility name’s] environmental services policy.vi. Handle textiles and laundry carefully; and in accordance with [facility name’s]

linen handling policy.

AND

b. Following Transmission Based Precautions, which are the second tier of basic infection control and are to be used in addition to Standard Precautions for residents who are suspected or confirmed to have COVID-19, for which additional precautions are needed to prevent infection transmission. There are three types of transmission-based precautions--contact, droplet, and airborne. The CDC is documenting the COVID-19 as droplet, however, the contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. Therefore, [facility name] will implement all three types of Transmission Based Precautions with resident’s who are suspected or confirmed with COVID-19. Specifically, respirators will be used when available and resident room doors will be closed as able. Transmission Based Precautions include -

i. [facility name] will ensure appropriate resident placement (isolation) in a single resident space/private room if available. If private rooms are unavailable, the IDT will make room placement decisions balancing risks to other residents; and by cohorting impacted residents. - Until information is available regarding viral shedding after clinical

improvement, discontinuation of isolation precautions should be determined on a case-by-case basis, in conjunction with the Infection Preventionist and the IDPH by calling 1-800-362-2736.

a. Factors that should be considered include presence of symptoms related to COVID-19 infection, date symptoms resolved, other conditions that would require specific precautions (e.g., MRSA, Clostridioides difficile), other laboratory information reflecting clinical status.

ii. [facility name] will use personal protective equipment (PPE) appropriately. Donning PPE upon room entry and properly discarding before exiting the resident room is done to contain pathogens. In the event there is a shortage of PPE, [facility name] will contact the IDPH by calling 1-800-362-2736 for assistance and guidance. PPE use will include:- Donning clean, non-sterile gloves upon entry into the resident room or

care area.

- Changing gloves if they become torn or heavily contaminated.

- Removing and discarding gloves when leaving the resident room or care area, and immediately performing hand hygiene.

- Donning a clean isolation gown upon entry into the resident room or

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care area.

- Changing the gown if it becomes soiled.

- Removing and discarding the gown in a dedicated container for waste or linen before leaving the resident room or care area.

- Disposable gowns will be discarded after use.

- If there are shortages of gowns, they will be prioritized for:

a. aerosol-generating procedures

b. care activities where splashes and sprays are anticipated

c. high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP. Examples include:

i. dressing

ii. bathing/showering

iii. transferring

iv. providing hygiene

v. changing linens

vi. changing briefs or assisting with toileting

vii. device care or use

viii. wound care

- Donning a respirator or facemask (if a respirator is not available) before entry into the patient room or care area.

a. N95 respirators or respirators that offer a higher level of protection will be used instead of a facemask when performing or present for an aerosol-generating/high-risk procedure.

- Disposable respirators and facemasks will be removed and discarded after exiting the resident’s room or care area.

- Resident doors will be closed unless there are safety considerations (the IDT will determine safety exclusions to closing the resident’s door).

- Performing hand hygiene after discarding the respirator or facemask.

- If reusable respirators (e.g., powered air purifying respirator/PAPR) are used, they will be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.

- [facility name] will refer to the following guidance on extended use of respirators: Strategies to Optimize the Current Supply of N95 Respirators.

- Donning eye protection (i.e., goggles or a disposable face shield that covers the front and sides of the face) upon entry to the resident room

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or care area.

a. Personal eyeglasses and contact lenses are NOT considered adequate eye protection.

- Removing eye protection before leaving the resident room or care area.

- Reusable eye protection (e.g., goggles) will be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.

- Disposable eye protection will be discarded after use.

iii. [facility name] will limit the transport and movement of residents who are suspected or confirmed with COVID-19 outside of their room to medically necessary purposes. When transport or movement is necessary, the following steps will occur:- The resident will use a facemask (as tolerated). If the resident cannot

tolerate a facemask, they should use tissues to cover their mouth and nose.

- Staff will remove and dispose of contaminated PPE and perform hand hygiene prior to transporting residents on Transmission Based Precautions.

- Staff will don clean PPE to handle the resident at the transport location.- In the event a resident requires transfer to the hospital, the EMS and

Hospital ED will be notified of the resident’s COVID-19 status.iv. [facility name] will use disposable or dedicated resident-care equipment (e.g.,

blood pressure cuffs). If common use of equipment for multiple residents is unavoidable, the equipment will be cleaned and disinfected before use on another resident.

v. [facility name] will prioritize cleaning and disinfection of the rooms of residents on Transmission Based Precautions ensuring rooms are frequently cleaned and disinfected (e.g., at least daily focusing on frequently touched surfaces and equipment in the immediate vicinity of the resident).

vi. [facility name] will ensure only essential personnel should enter the room and will implement staffing policies to minimize the number of HCP who enter the room (dedicated staff assignments).

vii. [facility name] will keep a log of all persons who care for or enter the rooms or care areas of impacted residents.

Postmortem Care

III. In the event a resident with suspected or confirmed COVID-19 expires while at [facility name],

a. The [facility name] Administrator, Infection Preventionist or designee will notify the resident’s physician and the OSDH by calling 1-877-215-8336.

i. All recommendations from the OSDH will be implemented.

b. The following PPE will be worn during post-mortem care.

i. Gloves, gown, facemask, and goggles

- The goal is to protect the face, eyes, nose, and mouth from splashes of potentially infectious body fluids. Additionally, if the staff member has

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cuts or wounds on their hands, double gloving is recommended.

ii. Upon receiving the order to transfer the resident’s body to the mortuary, [facility name] staff will inform the mortuary of the resident’s suspected or confirmed COVID-19 status and provide the mortuary with the OSDH number 1-877-215-8336 to allow the mortuary to seek guidance.

iii. The staff will greet the mortuary at the [facility name] entrance to screen the mortuary staff for potential COVID-19 and to ensure they perform hand hygiene and to provide them with necessary PPE.

References

CDC. (2020, March). Retrieved from CDC.gov: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/index.html

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SAMPLE POLICY FOR UNPAID SICK LEAVE

COMMUNITY UNPAID SICK LEAVE EXAMPLE POLICY

[COMMUNITY]

Department

Applies to:

__x__ [The Home]

__x__ [The Gardens]

__x__ [Parkside]

__x__ [The Woods]

__x__ [Rehabilitation Clinic]

Policy and Procedure

Original date: _____

Revision date: _______________

Regulatory References Signature ______________________________________

POLICY

Unpaid Leave Policy

PURPOSE

This policy provides guidelines for unpaid leave.

PROCEDURES

[COMMUNITY] reserves the right to amend or terminate this policy at any time. Please contact Human Resources to answer any questions you may have.

Staff may request an unpaid leave for personal, professional, or medical reasons, including pregnancy. Requests for leave are at the sole discretion of [COMMUNITY] and, specifically, are subject to approval by the appropriate administrative official within the employing unit and are approved at the discretion of the employing unit in consultation with Human Resources. A leave implies that the same or similar position will be held open for a staff member or will be made available upon her or his return.

GENERAL

Staff do not receive pay for holidays that occur during an unpaid leave.

Annual leave and sick leave do not accrue during an unpaid leave.

Available annual leave and sick leave must be exhausted prior to the approval of unpaid leave for medical leave.

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All requests for unpaid leave, whether for medical or personal purposes, shall be determined at the sole discretion of [COMMUNITY], consistent with all federal, state, and local laws, and with [COMMUNITY’S] business interests, as well as without imposing an undue hardship on [COMMUNITY].

Employees who fail to submit a timely submit a request and/or obtain approval for unpaid leave and who are absent from work without pre-approval of such unpaid leave may be subject to disciplinary action, up to and including termination.

Medical leave for Staff:

o Available sick leave and vacation leave balances must be exhausted prior to the use of unpaid medical leave.

o The employee must submit a written request to Human Resources setting forth the reasons for the unpaid medical leave at least ___ days in advance, or in the case of an emergency, as soon as practicable.

o Employees may be granted unpaid medical leave up to three months, at the sole discretion of [COMMUNITY].

o [COMMUNITY] reserves the right to require the employee to provide satisfactory medical documentation for medical leave which indicates a projected date for return to work, as well as reevaluation and/or medical verification of the employee's ability to return to work and other appropriate information. [COMMUNITY] may waive this requirement in workers' compensation, short-term disability, and long-term disability cases.

Personal leave for Staff:

o Available annual leave balances must be exhausted prior to the use of unpaid personal leave.

o The employee must first submit a written request to her/his immediate supervisor setting forth the reasons for the unpaid personal leave at least ___ days in advance, or in the case of an emergency, as soon as practicable.

o Once the immediate supervisor approves the leave, the employee must next submit a formal request for leave to Human Resources for approval.

o [COMMUNITY] reserves the right to require satisfactory documentation to substantiate the request for personal unpaid leave.

o Unpaid personal leave may be granted at the sole discretion of [COMMUNITY].

Staff placed on mandatory leave for self-quarantine for infectious diseases, including but not limited to coronavirus:

o Staff who meet the following criteria may be placed on a "monitored self-quarantine" prior to being permitted to return to work:

Staff traveling outside the United States or to areas identified as having a high risk of infection by the Centers for Disease Control and Prevention (CDC);

Staff who have reported possible contact with a person with an infectious disease, including but not limited to coronavirus,

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Staff who are demonstrating symptoms of an infectious disease, including but not limited to coronavirus,

Staff who meet the definition of a "Patient Under Investigation (PUI)," see Coronavirus Policy and Procedure.

o Mandatory leave for self-quarantine will be used to ensure that no symptoms develop during the stated incubation period. The quarantine shall last for 14-days, or for the amount of time recommended for incubation by the CDC. Employees required to be placed in self-quarantine are required to monitor their symptoms and report any medical diagnosis of infectious disease or other serious health condition, including but not limited to coronavirus, immediately to [COMMUNITY]. Upon such a report, [COMMUNITY] may require the employee's cooperation with any investigation required to identify other employees or residents of [COMMUNITY] who may be a PUI.

o Whether an employee is permitted to work remotely while on mandatory leave for self-quarantine will be determined on a case-by-case basis in the sole discretion of [COMMINITY].

o Staff who are placed on mandatory leave for self-quarantine and who are not approved to work remotely, must first utilize all available annual and sick leave, after which [COMMUNITY] will approve unpaid leave to permit employees to observe the mandatory leave for self-quarantine.

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SAMPLE POLICIES: CONTAINMENT STRATEGIES IN AN INFLUENZA PANDEMIC

A. CONTAINMENT STRATEGIES

A.1 General Infection Control

In general, facilities shall be kept clean and sanitized. Steps will be taken to educate residents, staff and visitors about fundamental control measures. Reminders about such measures will be posted in visible locations throughout our facilities.

Hand Hygiene

Hand washing and sanitizing are critical. Staff, residents and all visitors are encouraged to wash their hands frequently, especially when they are visibly soiled or have come in contact with mucous or other bodily secretions. When soap and water are not readily available, use an alcohol-based (60-percent alcohol) hand sanitizer when hands are not visibly soiled. If hands are visibly soiled, they must be washed with soap and water.

Respiratory Etiquette

Staff, visitors and residents will be educated on proper respiratory etiquette. All will be reminded to about the “sleeve sneeze” and coughing into the elbow. Signs shall be posted throughout our facilities and tissues and wastebaskets will be provided.

If someone is in a group and cannot be removed, the individual shall use a surgical mask (unless the individual cannot tolerate it or it interferes with the person’s breathing). This will help decrease the spread of droplets to others by coughing.

Social Distancing

Influenza is transmitted by droplets from the respiratory system, especially when you cough or sneeze, but can even be transmitted through speaking or singing. These droplets usually do not travel more than three feet from the person coughing, sneezing, etc., and therefore, keeping a “social distance” of three feet among the residents can reduce the spread of influenza.

Rotating times in common areas will be established so they are not as crowded. Residents shall be placed at least three feet apart at mealtimes or during therapy.

Contaminated Surfaces

It is critical to clean all surfaces that are suspected to be contaminated by a pandemic strain of influenza. Frequently touched surfaces such as counters, table tops, door knobs, telephones, TV knobs, computer keyboards, etc., shall be wiped down and disinfected frequently.

Some routine cleaning procedures may be temporarily discontinued because they might help spread the Influenza virus (like vacuuming or dusting) or due to staffing limitations. See Appendix B for additional cleaning tasks and other measures for reducing the spread of the disease.

A.2 Non-Pharmaceutical Interventions (NPI) and Containment during a Pandemic

A.2.1. Reduction of Social Interactions

During a pandemic, staff will be reminded that they conduct a vital service for others and therefore should reduce their exposure to other persons, whether they are known to be sick or not, wherever possible.

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Steps will be taken to limit our residents’ exposure, including the following:

The resident Admission Agreement provisions for advance notification of discharge will be waived for residents wishing to move home with families or friends.

Unnecessary travel by residents will be cancelled.

Trips for nonessential medical appointments will be cancelled.

Activity trips may be cancelled.

Group activities may be cancelled.

The Dining Room may be closed thereby requiring all meals to be served in the resident rooms. When residents must be taken out of the facility, they may be required to wear a surgical mask and latex gloves during the entire time they are away.

A.2.2. Self-Isolation

Our goal will be that sick visitors, staff and volunteers must be kept out. Signs and placards will be posted at all entrances. Families, friends, delivery and repair personnel, volunteers and staff must understand and respect this goal.

Persons who have been exposed to flu or who reasonably suspect that they have been exposed should also stay out of the facility. The following message will shall be communicated to all visitors and staff:

“If you have the flu or if you think you might have the flu or if you have been exposed to someone who has the flu (or even if you have been exposed to someone who became ill within two days of your exposure to them), PLEASE STAY OUT. If you MUST enter, please wear a mask, wash your hands frequently and avoid breathing or coughing/sneezing near anyone else. Please leave as soon as possible.”

Additional procedures that may be implemented include:

We will request that there be no visitation by children under age 12.

Signs will be posted urging visitors to not enter if they are sick or have been exposed to flu. Visitors will be screened for influenza like illness.

Visitation may be restricted to essential visitors only.

Essential visitors will be required to wash their hands upon entry and don a surgical mask.

People who enter the facility and find they are sick after arriving or within two days of leaving show let the facility know that the exposure has occurred.

A.2.3. Isolation of Residents

Residents who have a confirmed, probable, or suspected case of novel H1N1 should be kept in their rooms and the door should be kept closed. The following guidelines should be followed:

Isolation precautions shall be implemented. A sign indicating isolation precautions have been implemented within the room shall be mounted on, or by, the room door.

Only essential personnel or visitors should enter the room.

All individuals entering the resident’s room should take standard and contact precautions plus eye protection. Gloves, gowns and masks along with eye protection should be donned when

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entering the resident’s room. If the resident must be transported out of the room, he or she should wear a surgical mask to contain secretions when outside of the room and should be encouraged to perform hand hygiene frequently and follow respiratory etiquette.

A.2.4. Quarantine

If a definite exposure has occurred in a limited part of the facility, those individuals should be kept apart from the rest of the population as effectively as possible. Residents should be kept in their rooms; roommates who would have been exposed to the quarantined residents should also be quarantined.

The quarantine period would be 7 days. If the individual who was exposed receives antiviral medications following the exposure, the quarantine period would end when the person remains well for 72 hours after receiving the medication.

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SAMPLE POLICIES: ADMISSIONS IN AN INFLUENZA PANDEMIC

B. ADMISSIONS

All admission applicants, to all levels of care, must be screened for signs and symptoms of pandemic influenza prior to acceptance into our facilities. Guidelines on laboratory testing from the PA Department of Health and the CDC will be followed as part of the screening of applicants.

Priority for nursing home or Personal Care Home admissions will be given to existing residents in other levels of care. Independent Living residents who are ill with the H1N1 flu should be admitted only if other care arrangements (care from family members or friends, temporarily moving to a loved one’s home, etc.) are not possible.

Depending on the circumstances (the availability of staff and essential supplies, the severity of the strain, etc.), the decision may be made to close our facilities to new admissions except for residents from other levels of care. The decision to close our facilities to admission will be made in consultation with the [Board of Directors, Executive Director, X County Emergency Management Office and the Oklahoma State Department of Health].

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CALL LOG for Family/Resident Questions and Concerns

Date Time of Call

Name

(Family Member or Resident)

Resident Room #

Question/Comment Resolved?

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Start of Shift Daily Employee Screening Log

Date:

Name Shift Temperature Symptoms of COVID-19?

(Cough, Sore Throat, Shortness of Breath?)

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

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Checklist for Temporary Living Quarters for Staff

Inventory of vacant/model apartments available for temporary housing

Cots

Pillows

Bedding

Basic Toiletry Needs

Extra food available

Plan for serving food for employees (time, place, etc.)

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