Long-Term Care and COVID-19
By Lisa Van Duyn, Vice President, Patient Safety & Service Excellence
As your Senior Care Risk Resource partner, ProAssurance encourages strong infection control practice and prevention strategies to help mitigate the spread of the Novel Coronavirus-19 (COVID-19) and any other seasonal respiratory infections or communicable illnesses and diseases.
Currently, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) reports approximately 107,000 confirmed cases, and that number is rising. Washington was one of the first states to report an outbreak of COVID-19 when residents of a long-term care facility were diagnosed and succumbed to the virus. COVID-19, although a new virus, is not unlike seasonal respiratory flu. Residents present with fever, congestion, upper respiratory infection signs and symptoms, general malaise, and body aches.
On March 4, the Center for Medicare & Medicaid Services (CMS) announced to hospice, hospital, and nursing facilities actions to address the spread of Coronavirus and issued a call to action to healthcare providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Starting with nursing homes and hospitals, survey agencies and accrediting organizations will focus facility inspections on issues related to infection control as well as other health and safety threats, including allegations of abuse. CMS issued memoranda to, “[I]nspect thousands of Medicare-participating health care providers across the country, including nursing homes and hospitals.” The memoranda was issued to state agencies, state survey agency directors, and accrediting organizations.
Responding to COVID-19
In light of CMS memoranda and in order to enhance a safe environment for patients, staff, and visitors, we encourage your facility to review and make necessary updates to your infection control policies and procedures as well as your emergency preparedness plan. From a risk management and resident safety perspective, reinforcing the following with care team members, residents, and visitors may help prevent the spread of COVID-19 and other communicable illnesses:
- Encourage team members and visitors to stay home if they are experiencing respiratory flu-like symptoms or are febrile.
- Reinforce, especially with new team members, strict adherence to your handwashing policy─be sure to “scrub in” and “scrub out” before and after each resident encounter. Ensure alcohol-based hand sanitizers are available immediately outside of and inside each resident’s room. Experts report this is the most important aspect to curb the spread of infection.
- Consider limiting large gatherings of residents in common areas. Also, have hand sanitizers readily available in these areas.
- Reinforce and re-train team members on expectations to protect themselves, residents, and visitors regarding infection control practices and adherence to infection control policies and procedures.
- Practice good respiratory hygiene throughout the facility. Engage team members, residents, and visitors facility-wide to contain the spread of respiratory droplets. Remind everyone to cough or sneeze into their elbow or use a tissue to contain droplets. Experts also suggest avoiding hand-to-hand contact and suggest knuckle bumps as a greeting instead of a handshake.
- Place a trashcan close to the resident for disposal of tissues and other contaminated products.
- Closely monitor residents, especially newly admitted residents, team members, and visitors for respiratory flu-like symptoms; contact the facility’s medical director or the resident’s physician as necessary for new care orders and diagnostic tests. Follow WHO, CDC, state, and local health department guidelines if the resident has a positive COVID-19 test result. Experts may suggest a 14-day quarantine of the resident and those who may have been in close contact.
- Ensure newly admitted residents or residents who have been transferred back to the facility from an acute care hospital are thoroughly assessed for respiratory flu-like symptoms. If possible, strategically place asymptomatic residents in rooms away from residents who are exhibiting flu-like symptoms, or have recently been diagnosed with respiratory flu. Check to see if the resident has received the seasonal flu shot. Experts report it is not too late to receive a flu shot.
- Have shift team huddles to communicate regarding residents that may be exhibiting respiratory flu-like symptoms.
- Make resident rounds more frequently to assess for early changes in a resident’s physical, mental, or ambulatory status and condition. Communicate changes to team members and apprise the resident’s physician or healthcare provider as necessary. Follow your facility’s fall prevention and management guidelines to determine if the resident meets criteria or if additional precautions are needed.
- Implement isolation precautions as necessary.
- Use signage at entrances to alert visitors there may be limitations to entry, based on screening of their health history, illnesses, and travel abroad. Also, consider restricting visitors of a certain age.
- Consult with your medical director, infection control professional, WHO, CDC, CMS, state, and or local health authorities for new or additional measures necessary to ensure regulatory compliance and the safe care of residents and team members.
- Monitor your supplies, especially personal protective equipment, to protect against shortages.
- Finally, ensure resident medical records accurately reflect the care you provided and any precautions taken. Be sure to document changes made to existing facility policies, procedures, and plans. Also document increased infection control surveillance, including facility maintenance records, and any additional team member training.
Information regarding COVID-19 is rapidly changing. Please closely monitor the CDC, WHO, CMS, and your state and local health authorities’ websites for the most current information, reporting requirements, care guidance statements, and the need to activate your emergency preparedness plan.
The CDC has excellent resources for infection prevention and control, surveillance monitoring, best practices, and staff training. These are free resources. The list below is not comprehensive however, it includes a number of documents/resources you may find beneficial.
ProAssurance Risk Resource advisors are ready to assist you as you navigate the current COVID-19 outbreak. We are also available to assist you with any other risk and resident safety challenges. Contact us at 844-223-9648 or RiskAdvisor@ProAssurance.com.
References and Online Resources:
For up to the minute information about COVID-19 visit the CDC or WHO websites