MedBridge has worked with Shelley Bhola RN-BC, BSN, MSN, PHN, Infection Prevention Specialist, to put together resources for facilities and providers to use for education and preparation during the coronavirus outbreak:
- Community Preparedness Guidelines for COVID-19 – Article
- Checklist for Inpatient Communities During the COVID-19 Outbreak – Article [currently viewing] & Downloadable Flyer
- COVID-19 Facility Policy – Downloadable Flyer
- A Healthcare Worker’s Guide to Staying Healthy Amid the COVID-19 Pandemic – Article
- Free Patient Education Videos: How to Protect Yourself Against the Coronavirus, and 5 Handwashing Steps You Should Follow
Key goals for the U.S. healthcare system in response to the COVID-19 outbreak are to:
- Reduce morbidity and mortality
- Minimize disease transmission
- Protect healthcare employees
- Preserve healthcare system functioning
Long-term care facilities have experience managing respiratory infections and outbreaks among residents and staff and should apply the same outbreak management principles to COVID-19. In addition, the following checklist will be initiated:
Identify Plan and Resources
1. Identify public health and professional resources.
- Local health department contact
- State health department contact
- State long-term care professional/trade association
2. Identify contacts for local, regional, or state emergency-preparedness groups, especially bioterrorism/communicable disease coordinators.
3. Identify contacts at local hospitals in preparation for the potential need to hospitalize residents or receive discharged residents from the hospital.
If a resident is referred to a hospital, coordinate transport with local hospital, local health department, and medical transport service/emergency medical service to ensure that the resident can be safely transported and received by the facility.
4. Perform surveillance to detect respiratory infections, including COVID-19.
- Assign one person to monitor public health updates from local and state public health departments.
- Implement protocol for monitoring of influenza-like-illness among residents and associates.
- Keep line listing on each unit and monitor 24/7.
- Assess all residents/staff with respiratory symptoms for:
- Travel to area with COVID-19 in 14 days prior to onset of illness
- Have family or visitors who have traveled to an area with COVID-19
- Any diagnostic testing
- Symptoms of COVID-19 are cough, fever, and shortness of breath.
5. Immediately contact your local health department if a resident meets exposure and symptom criteria.
- Your local health department will help assess the situation and provide guidance for further actions.
- Specimens for COVID-19 will only be collected in the community if directed by the local health department.
Protecting Visitors and Associates
1. Educate all staff, residents, and family members of residents about COVID-19.
- Educate on potential harm from respiratory illnesses to nursing home residents as well as basic prevention and control measures for respiratory infections such as influenza and COVID-19.
- Include the following topics in education:
- Hand hygiene – view and share our free video on 5 Handwashing Steps You Should Follow
- Respiratory hygiene and cough etiquette, including sneezing/coughing into tissue or elbow, placing used tissues in a waste receptacle, and washing hands immediately after using tissues
- Use of personal protective equipment (PPE) recommended when caring for those suspected or confirmed of having COVID-19, including gown, gloves, mask (or N95 respirator), and eye protection that covers the front and sides of the face.
- Screening visitors for illness
- Limiting visitors during outbreaks
2. Review, implement, and reinforce an infection control plan for preventing communicable disease among residents, visitors, and facility staff. The plan should include:
- A policy for when direct care staff should use standard, droplet ,and contact precautions for residents with symptoms of respiratory infection
- A plan for implementing respiratory hygiene throughout the community
- A plan for cohorting symptomatic residents or groups using one or more of the following strategies:
- Confining symptomatic residents and exposed roommates to their rooms
- Placing symptomatic residents together in one area of the community
- Closing units where symptomatic and asymptomatic residents reside
- Cohorting staff on either affected or non-affected units to prevent transmission between units
- Canceling events in the community where many people come together
- Cleaning and disinfecting high-touch surfaces with EPA-registered disinfectant with label claim of effectiveness against human coronavirus or merging viral pathogens
1. Develop criteria and protocols for closing units or the entire community to new admissions when COVID-19 has been identified in the community.
- Inform discharge planners within your healthcare network that your community is closed to new admissions.
- If a section of the community will be closed but other units will remain open to new admissions, develop communications protocol to inform new residents of COVID-19 in the community.
2. Develop criteria and protocols for enforcing visitor limitations.
- If COVID-19 is identified in the surrounding community, determine a method to screen visitors for respiratory illness symptoms.
- Consider screening visitors for recent travel to high-risk areas with COVID-19 transmission.
- Post signs at the entry, the reception area, and throughout the community to help visitors, staff, and volunteers self-identify relevant symptoms and travel history.
- Educate visitors and family members not to visit the community if they are experiencing respiratory symptoms.
3. If visitors are allowed to enter the room of a resident with confirmed or suspected COVID-19, the facility will:
- Enact a policy defining what PPE should be used by visitors
- Before visitors enter the resident’s room, associates will provide instructions to visitors on hand hygiene, limiting surfaces touched, and appropriate use of PPE
- Maintain a record of all visitors who enter and exit the room
- Ensure visitors limit their movement within the community, avoiding the cafeteria and other common areas
Associate Health and Contingency Planning
1. Implement an occupational health plan with a non-punitive sick leave policy to address the needs of symptomatic staff, including:
- Staff, other caregivers, and volunteers should not report to the community if they are symptomatic with fever or respiratory symptoms and must report any such symptoms to human resources
- How to handle personnel who develop symptoms while at work
- Staff who do develop COVID-19 require two negative tests before isolation can be discontinued (this guidance may change as the situation evolves)
- How to accommodate personnel who need to care for ill family members
- Educate staff to self-assess and report symptoms of respiratory illness before reporting for work
- Identify staff who may be at higher risk for severe COVID-19 disease and attempt to assign them to unaffected units
2. Develop contingency staffing and resident placement plans.
- Identify minimum staffing needs and prioritize critical and non-essential services based on residents’ health status, functional limitations, disabilities, and essential facility operations.
- Contact your local healthcare coalition for guidance on altered standards of care in case residents need acute care and hospital beds are not available.
- Strategize how your community can help increase hospital bed capacity in the community.
- Establish memoranda of agreement with local hospitals for admission to the long-term care community of non-influenza residents to facilitate utilization of acute care resources for more seriously ill patients.
Take this checklist on the go with a PDF version: