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Prevention In Long-Term Care Facilities

 The general strategies CDC recommends to prevent the spread of COVID-19 in LTCF are the same strategies LTCF use every day to detect and prevent the spread of other respiratory viruses like influenza.

Prevent the introduction of respiratory germs INTO your facility

  • Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory infection.
  • Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory infection.
  • Assess residents’ symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.

Prevent the spread of respiratory germs WITHIN your facility

  • Monitor residents at least once per shift and employees at least once prior to starting their shift for fever or respiratory symptoms.
  • Restrict 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).
  • In general, for care of residents with undiagnosed respiratory infection use Standard, Contact, and Droplet Precautions with eye protection unless suspected diagnosis requires Airborne Precautions (e.g., tuberculosis).
  • Healthcare personnel should monitor their local and state public health sources to understand COVID-19 activity in their community to help inform their evaluation of individuals with unknown respiratory illness. If there is transmission of COVID-19 in the community, in addition to implementing the precautions described above for residents with acute respiratory infection, facilities should also consult with public health authorities for additional guidance.
  • Post signs throughout the facility describing ways to prevent the spread of germs. https://www.cdc.gov/coronavirus/2019-ncov/downloads/stop-the-spread-of-germs.pdf
  • Support hand and respiratory hygiene as well as cough etiquette by residents, visitors, and employees.
  • Ensure employees clean their hands according to CDC guidelines, including before and after contact with residents, after contact with contaminated surfaces or equipment, and after removing personal protective equipment (PPE).
  • Put alcohol-based hand rub in every resident room (ideally both inside and outside of the room).
  • Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing.
  • Identify dedicated employees to care for COVID-19 patients and provide infection control training.
  • Provide the right supplies to ensure easy and correct use of PPE.
  • Post signs on the door or wall outside of the resident room that clearly describes the type of precautions needed and required PPE.
  • Make PPE, including facemasks, eye protection, gowns, and gloves, available immediately outside of the resident room when it’s determined PPE is needed for the resident.
  • Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE.
  • Perform hand hygiene upon exiting patient rooms.

Prevent the spread of respiratory germs BETWEEN facilities

  • Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
  • Report any possible COVID-19 illness in residents and employees to the local health department, including your state Healthcare-associated Infections and Antimicrobial Resistance (HAI/AR) coordinator.

Emergency Preparedness Plans

  • Facilities should develop or review current emergency preparedness plans.
  • One part of an overall emergency plan is preparedness. Preparedness includes organizing, training, gathering resources, exercising and evaluating plans.
  • Contact local public health and emergency planning partners to understand current community response plans.

Inform

In an effort to reduce fear and anxiety about COVID-19, facilities should describe what actions the facility is taking to protect staff and residents.

  • Communicate about COVID-19 with your staff. Share information about what is currently known about COVID-19 and your facility’s preparedness plans.
  • Communicate about COVID-19 with your patients and family members. Provide updates about any changes to your policies regarding appointments and visitors and any guidance to patients about providing non-urgent patient care by telephone. Consider using your facility’s website or social media pages to share updates.
  • Communicate about COVID-19 with service providers (e.g., vendors, doctors, service organizations and government contacts) about what is currently known about COVID-19 and your facility’s preparedness plans.

Training for Facilities and Staff

  • Facilities should provide education and training on proper hand hygiene and donning and doffing of personal protective equipment.
  • Training should include information on cleaning and disinfection practices.

Resources

  • Facilities should evaluate their supply chain and ensure availability of PPE and cleaning and disinfection products. If facilities are unable to obtain necessary resources, contact your local health department.
  • It is critical that facilities not stockpile supplies.
  • If vendors are unable to supply facility orders for PPE, facilities should reach out to other vendors to obtain necessary PPE.
  • Other options may include the use of reusable isolation gowns.
  • To conserve PPE, staff should attempt to perform more than one task when they enter the resident’s room (e.g., medication administration, vital signs, bathing, toileting).
  • Review of current CDC guidance, “Healthcare Supply of Personal Protective Equipment.” This guidance is specific to Coronavirus and PPE availability and includes recommendations for:
    • Who needs PPE
    • Who doesn’t need PPE
    • Manufacturers and distributors
    • Strategies for optimizing supply of N95 respirators 
  • Frequently asked questions about respirators and their use. Following is the link for this guidance: https://www.cdc.gov/coronavirus/2019-ncov/hcp/healthcare-supply-ppe.html
  • Follow-up with your local health department and local emergency management for resource needs, such as PPE.    

Exercise/Evaluate

  • For technical assistance, facilities should contact local/regional emergency preparedness members or healthcare coalitions (i.e., members of your local emergency planning committee, like local health department, local emergency management, hospitals, transportation, community groups).
  • Consider scenarios of potentials events to ensure emergency plans are effective.
  • Determine the gaps and take corrective actions to address them.