Checklist for Inpatient Communities During the COVID-19 Outbreak

COVID-19 Checklist

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:

  1. Community Preparedness Guidelines for COVID-19 – Article
  2. Checklist for Inpatient Communities During the COVID-19 Outbreak – Article [currently viewing] & Downloadable Flyer
  3. COVID-19 Facility Policy – Downloadable Flyer
  4. A Healthcare Worker’s Guide to Staying Healthy Amid the COVID-19 Pandemic – Article
  5. 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

Download this prepared COVID-19 Facility Policy

Implementing Restrictions

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:

COVID-19 Checklist

Resources