Read Van Duyn’s COVID-19 Policy

COVID-19 Policy Update 9/15/2020

Van Duyn Center for Rehabilitation and Nursing

COVID-19 Action Plan

 Date Initiated: February 2020

Date Revised:  09/03/20; 06/30/20; 06/24/20; 06/05/20; 05/20/20; 05/11/20; 05/06/2020; 04/29/2020; 03/17/20; 03/13/20; 03/07/20; 03/06/20

PURPOSE:

To provide guidelines for the prompt detection and effective triage and isolation of potentially infectious patients to prevent unnecessary exposures among patients and healthcare personnel at the facility.

 Person-to-person spread

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet)
  • Via respiratory droplets produced when an infected person coughs or sneezes.
  • These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Spread from contact with infected surfaces or objects

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.

When does spread happen?

  • People are thought to be most contagious when they are most symptomatic (the sickest).
  • Some spread might be possible before people show symptoms; there have been reports of this with this new coronavirus, but this is not thought to be the main way the virus spreads.

Symptoms

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Prevention:

There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). The best way to prevent illness is to avoid being exposed to this virus.

The CDC recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

Treatment:

There is no specific antiviral treatment recommended for COVID-19. People with COVID-19 should receive supportive care to help relieve symptoms. For severe cases, treatment should include care to support vital organ functions.

  • People who think they may have been exposed to COVID-19 should contact their healthcare provider immediately.

DEFINITIONS

  • Healthcare Personnel (HCP) – HCP refers to all persons, paid and unpaid, working in healthcare settings engaged in patient care activities, including: patient assessment for triage, entering examination rooms or patient rooms to provide care or clean and disinfect the environment, obtaining clinical specimens, handling soiled medical supplies or equipment, and coming in contact with potentially contaminated environmental surfaces.

 POLICY:

  1. Monitoring of Residents:
    1. Prior to Entry:
      1. Residents will be screened by the Corporate Admissions Team for the presence of 1 negative COVID-19 test result during hospitalization prior to admission.

 

  1. After Admission
    1. All new admissions/re-admissions will be screened/monitored every shift for 14 days by obtaining Vital Signs and Respiratory Monitoring:
      1. Temperature, Pulse, Respirations, Blood Pressure, Pulse Oximetry
      2. Cough, SOB, Sore Throat
    2. They will have a COVID-19 test performed within 24 to 48 hours of admission/re-admission.
  1. Outside Appointments
    1. All appointments should be restricted to those only that are medically necessary.
      1. Obtain baseline temperature before leaving and VS and Respiratory Monitoring every shift x 14 days upon return from appointment.
    2. All residents receiving dialysis will need VS and Respiratory Monitoring every shift.
  • All residents receiving dialysis will be tested for COVID-19 weekly or with any symptoms.
  1. All HCP and other facility staff shall wear a facemask while within 6 feet of residents. Extended wear of facemasks is allowed; facemasks should be changed when soiled or wet and when HCP go on breaks. The facility will attempt to bundle care and minimize the number of HCP and other staff who enter rooms to reduce the number of personnel requiring facemasks.
  2. If there are suspected cases of COVID-19 in the facility:
  1. Residents suspected of infection with COVID-19 should be given a facemask to wear, and the facility must immediately contact the NYSDOH.
  2. The resident must be isolated in a separate room with the door closed.
  3. Staff attending the resident if and until they are transferred should wear gowns, gloves, eye protection (goggles or a face shield), and facemasks and should maintain social distancing of at least six (6) feet from the resident except for brief, necessary interactions.
  4. The facility will bundle care and minimize the number of HCP and other staff who enter rooms to reduce the number of personnel requiring facemasks.
  1. If there are confirmed cases of COVID-19 in the facility:
    1. Notify the local health department and NYSDOH if not already involved.
    2. Actively monitor all residents on affected units once per shift.
      1. This monitoring must include a symptom check, vitals, lung auscultation, and pulse oximetry.
    3. Assure that all residents in affected units remain in their rooms. Cancel group activities and communal dining. Offer other activities for residents in their rooms to the extent possible, such as video calls.
    4. Residents must wear facemasks when HCP or other direct care providers enter their rooms, unless such is not tolerable.
    5. Do not float staff between units.
    6. Cohort residents with COVID-19 with dedicated HCP and other direct care providers. Minimize the number of HCP and other direct care providers entering rooms.
    7. All residents on affected units should be placed on droplet and contact precautions, regardless of the presence of symptoms and regardless of COVID-19 status.
    8. HCP and other direct care providers should wear gown, gloves, eye protection (goggles or a face shield), and N95 respirators (or equivalent) if the facility has a respiratory program with fit tested staff and N95s. Otherwise, HCP and other direct care providers should wear gown, gloves, eye protection, and facemasks. Facilities may implement extended use of eye protection and facemasks/N95s when moving from resident to resident (i.e. do not change between residents) unless other medical conditions which necessitate droplet precautions are present. However, gloves and gowns must be changed and hand hygiene must be performed.
    9. For residents who initially test negative, re-testing should be performed immediately if they develop symptoms consistent with COVID-19.

Testing Requirements:

The facility can meet the testing requirements through the use of rapid point-of-care (POC) diagnostic testing devices or through an arrangement with an offsite laboratory.

“Facility staff” includes employees, consultants, contractors, volunteers, and caregivers who provide care and services to residents on behalf of the facility, and students in the facility’s nurse aide training programs or from affiliated academic institutions.

Testing of Staff and Residents with COVID-19 Symptoms or Signs

Staff with symptoms or signs of COVID-19 must be tested and are expected to be restricted from the facility pending the results of COVID-19 testing. If COVID-19 is confirmed, see “Protocols for Personnel to Return to Work Following Suspected or Confirmed Positive for the COVID-19 Virus” below.  Staff who do not test positive for COVID-19 but have symptoms should follow facility policies to determine when they can return to work.

Residents who have signs or symptoms of COVID-19 must be tested. While test results are pending, residents with signs or symptoms should be placed on transmission-based precautions (TBP) in accordance with CDC guidance. Once test results are obtained, the facility must take the appropriate actions based on the results.

Testing of Staff and Residents in Response to an Outbreak

An outbreak is defined as a new COVID-19 infection in any healthcare personnel (HCP) or any nursing home-onset COVID-19 infection in a resident.  A resident who is admitted to the facility with COVID-19 does not constitute a facility outbreak.

Upon identification of a single new case of COVID-19 infection in any staff or residents, all staff and residents will be tested, and all staff and residents that tested negative will be retested every 3 days to 7 days until testing identifies no new cases of COVID-19 infection among staff or residents for a period of at least 14 days since the most recent positive result.

For individuals who test positive for COVID-19, repeat testing is not recommended. A symptom-based strategy is intended to replace the need for repeated testing.

Other Testing Considerations

In keeping with current CDC recommendations staff and residents who have recovered from COVID-19 and are asymptomatic do not need to be retested for COVID-19 within 3 months after symptom onset.

Routine Testing of Staff and Residents

Routine testing of asymptomatic residents is not recommended unless prompted by a change in circumstances, such as the identification of a confirmed COVID-19 case in the facility. Facilities may consider testing asymptomatic residents who leave the facility frequently, such as for dialysis or chemotherapy.

Facility staff will be tested at a minimum of weekly.  See “Monitor and Manage Ill and Exposed Healthcare Personnel.”

Refusal of Testing

Staff who have signs or symptoms of COVID-19 and refuse testing are prohibited from entering the building until the return to work criteria are met.

If outbreak testing has been triggered and a staff member refuses testing, the staff member will be prohibited from entering the building until the procedures for outbreak testing have been completed.

Staff who refuse routine testing will be prohibited from entering the building.

Residents (or resident representatives) may exercise their right to decline COVID-19 testing.  If a resident has symptoms consistent with COVID-19 or has been exposed to COVID-19, or if there is a facility outbreak and the resident declines testing, he or she should be placed on or remain on TBP until he or she meets the symptom-based criteria for discontinuation.

Manage Visitor Access and Movement within the Facility

  1. Visitation has been suspended in the facility.
  2. Visitation may be allowed when medically necessary (i.e. visitor is essential to the care of the patient or is providing support in imminent end-of-life situations) or for family members of residents in imminent end-of-life situations, this will be a case by case basis for arrangements to be made for the visitation, and those providing Hospice care. Any such visitors shall be subject to the same health checks for all HCP and other facility staff.
  3. The duration and number of visits will be minimized. Visitors will be required to wear a facemask while in the facility and will only be allowed in the resident’s room.
  4. The facility will provide other methods to meet the social and emotional needs of residents, such as video calls.
  5. The facility has signage posted notifying the public of the suspension of visitation and has notified resident family members.

Monitor and Manage Ill and Exposed Healthcare Personnel

  1. Health checks for all HCP and other facility staff will be completed at the beginning of each shift. This includes all personnel entering the facility regardless of whether they are providing direct patient care (See attached Staff Monitoring Log).
  2. Facility staff performing health checks must wear a facemask.
  3. HCP and other facility staff with symptoms or with T ≥ 100.0 F will be sent home, and HCP and other facility staff who develop symptoms or fever while in the facility will immediately be sent home.
  4. HCP and other facility staff will be screened for any travel states that have a significant degree of community-wide spread of COVID-19 and are listed as restricted states per NYS. If travel occurred in one of the identified restricted states:
    1. Essential workers should seek diagnostic testing for COVID-19 as soon as possible upon arrival (within 24 hours) to ensure they are not positive.
    2. Essential workers should monitor temperature and signs of symptoms, wear a face covering when in public, maintain social distancing, clean and disinfect workspaces for a minimum of 14 days.
    3. Essential workers, to the extent possible, are required to avoid extended periods in public, contact with strangers, and large congregate settings for a period of, at least, 7 days.
  1. All full-time employees, contract staff, medical staff, operators and administrators will be tested for COVID-19 at a minimum of weekly. Staff that refuses testing will not be allowed to work.

Protocols for Personnel to Return to Work Following COVID-19 Exposure

  1. HCP who are asymptomatic contacts of confirmed or suspected cases should self-monitor twice a day (temperature, symptoms), and undergo temperature monitoring and symptom checks at the beginning of each shift and at least every 12 hours. At the current time, staff who are recovered from Covid-19 should wear a facemask until 14 days after onset of illness if mild symptoms persist but are improving. Staff who are asymptomatic contacts should wear a facemask while working until 14 days after the last high-risk exposure.
  2. At the current time, staff working under these conditions should preferentially be assigned to patients at lower risk (e.g. on units established for patients with confirmed Covid-19) as opposed to higher-risk patients (e.g. severely immunocompromised, elderly). As this pandemic grows, all staff will need to be assigned to treat all patients regardless of risk level.
  3. If staff who are asymptomatic contacts working under these conditions develop symptoms consistent with Covid-19, they should immediately stop work and isolate at home. Testing should be prioritized for hospitalized health care workers. All staff with symptoms consistent with Covid-19 should be dealt with as if they have this infection regardless of the availability of test results.

Protocols for Personnel to Return to Work Following Suspected or Confirmed Positive for the COVID-19 Virus:

  1. Employees who test positive for COVID-19 but remain asymptomatic must be off work for a minimum of 14 days from first positive test date and a negative test result.
  1. Symptomatic employees may return to work after 14 days from the onset of symptoms, provided at least 3 days (72 hours) have passed since resolution of fever without the use of fever-reducing medications and respiratory symptoms are improving and a negative test result.

Train and Educate Healthcare Personnel

  1. Provide HCP with job- or task-specific education and training on preventing transmission of infectious agents, including refresher training.
  2. HCP must be medically cleared, trained, and fit tested for respiratory protection device use (e.g., N95 filtering face piece respirators).
  3. 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.

Implement Environmental Infection Control

  1. Dedicated medical equipment should be used for patient care.
  2. All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
  3. Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  4. 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 COVID-19 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed. Products with EPA-approved emerging viral pathogens claims are recommended for use against COVID-19.

Establish Reporting within Healthcare Facilities and to Public Health Authorities

  1. Communicate and collaborate with public health authorities.
  2. Promptly notify state or local public health authorities of patients with known or suspected COVID-19 (i.e., PUI). The Infection Control Preventionist is responsible for communication with public health officials and dissemination of information to HCP.

References:

https://commerce.health.state.ny.us/hpn/ctrldocs/alrtview/postings/Advisory_HCP_return_to_work_20200316_final_1584392898610_0.pdf

https://apps.health.ny.gov/pub/ctrldocs/alrtview/postings/Nursing_Home_Guidance_3_1583593822992_0.6.20_with_signage.pdf

https://commerce.health.state.ny.us/hpn/ctrldocs/alrtview/postings/COVID19_LTCF_guidance_20200312_1584137320257_0.pdf

https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html

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

https://commerce.health.state.ny.us/hpn/ctrldocs/alrtview/postings/DAL_TESTING_ACF_20-14_&_NH_20-07_1589228239828_0.pdf

https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19

1 Comments

  1. Nancy Maria Burnett on March 23, 2020 at 10:13 am

    Thank you for taking these precautions.

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