Facility Management

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Make Plans and Identify Resources

  • Cancel all group activities and communal dining. 
  • Dedicate space in the facility to care for residents with confirmed COVID-19. 
  • This could be a dedicated floor, unit, or wing in the facility or a group of rooms at the end of the unit that will be used to cohort residents with laboratory-confirmed COVID-19. 
  • Assign dedicated staff to work only in this area of the facility. 
  • To the extent possible, restrict access of ancillary personnel to the unit. 
  • To the extent possible, assign environmental services staff to work only on the unit. 
  • Have a plan for how residents in the facility who develop COVID-19 will be managed (e.g., transfer to a single room, prioritize for testing, transfer to COVID-19 unit if positive). 
  • Closely monitor roommates and other residents who may have been exposed to an individual with COVID-19 and, if possible, avoid placing unexposed residents into a shared space with them.

Review and update your pandemic influenza preparedness plans. The same planning applies to COVID-19.

  • Identify public health and professional resources and contacts for local, regional or state emergency preparedness groups.
  • Identify contacts at local hospitals ahead of any potential need to hospitalize residents or to receive residents discharged from the hospital.
  • Ensure facility transfer protocols are in place for residents with an acute respiratory illness.
  • Ensure plans are in place to track and clear staff to return to work after illness.
  • Ensure plans are in place to address insufficient staffing.
  • Establish contingency plans for resident discharge or transfer in the event the facility has insufficient staffing to safely meet resident care needs. 

Prevent the spread of COVID-19 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 PCHD liaisons. 
  • Staff who work in multiple locations may pose higher risk and should be asked about exposure to facilities with recognized COVID-19 cases. 
  • Consider encouraging staff to work at only one facility. 
  • When transmission in the community is identified, nursing homes and assisted living facilities may face staffing shortages. Facilities should develop (or review existing) plans to mitigate staffing shortages.

Assign One or More Individuals with Training in Infection Control to Provide On-Site Management of the IPC Program

From CDC “Preparing for COVID-19 in Nursing Homes” (June 25, 2020)
  • This should be a full-time role for at least one person in facilities that have more than 100 residents or that provide on-site ventilator or hemodialysis services. Smaller facilities should consider staffing the IPC program based on the resident population and facility service needs identified in the facility risk assessment.
  • CDC has created an online training course that can be used to orient individuals to this role in nursing homes.

Create a Plan for Testing Residents and Healthcare Personnel for SARS-CoV-2.

From CDC “Preparing for COVID-19 in Nursing Homes” (June 25, 2020): 
  • Testing for SARS-CoV-2, the virus that causes COVID-19, in respiratory specimens can detect current infections (referred to here as viral testing or test) among residents and HCP in nursing homes.
  • The plan should align with state and federal requirements for testing residents and HCP for SARS-CoV-2 and address:
    • Triggers for performing testing (e.g., a resident or HCP with symptoms consistent with COVID-19, response to a resident or HCP with COVID-19 in the facility, routine surveillance)
    • Access to tests capable of detecting the virus (e.g., polymerase chain reaction) and an arrangement with laboratories to process test
      • Antibody test results should not be used to diagnose someone with an active SARS-CoV-2 infection and should not be used to inform IPC action.
    • Process for and capacity to perform SARS-CoV-2 testing of all residents and HCP
    • A procedure for addressing residents or HCP who decline or are unable to be tested (e.g., maintaining Transmission-Based Precautions until symptom-based criteria are met for a symptomatic resident who refuses testing)
  • Additional information about testing of residents and HCP:

Inform Residents and Families

  • Send letters or emails to families (example template) advising them that no visitors will be allowed in the facility except for certain compassionate care situations, such as end of life situations. 
  • Use of alternative methods for visitation (e.g., video conferencing) should be facilitated by the facility. 
  • Educate residents and families including information about COVID-19; actions the facility is taking to protect them and/or their loved ones, including visitor restrictions; and actions they can take to protect themselves in the facility, emphasizing the importance of social distancing, hand hygiene, respiratory hygiene and cough etiquette, and wearing a cloth face covering. 
  • Have a plan and mechanism to regularly communicate with residents, family members and HCP, including if cases of COVID-19 are identified among residents or HCP. 

Governor’s Executive Orders on informing residents and families

Governor’s Executive Order 2020-35 states that facilities must:

  • Report to current residents and family members the number of diagnosed cases and deaths due to COVID-19 occurring within the population of the facility within 24 hours of confirming such information, and provide regular updates on their activities to keep residents safe to residents and their families; 
  • Upon receipt of a completed application to a congregate setting and a request from a prospective resident, their next of kin or guardian, report the number of cases and deaths due to COVID-19 occurring within the population of the congregate setting to the prospective resident, their next of kin and any guardian; 
  • Upon acceptance of the transfer of a resident into their congregate setting and upon request from the transferee, but before the transfer is completed, report to the transferring resident, their next of kin and any guardian, the number of cases and deaths due to COVID-19 occurring within the population of the congregate setting.

CMS requirements for informing residents and their representatives

  • CMS requires Medicare and Medicaid-participating nursing homes to inform its residents and their representatives by 5pm the next calendar day following the occurrence of: 
    • A single confirmed case of COVID-19; -OR- 
    • 3 or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other. 
  • ADHS has a templated letter you can download and edit to meet your facility’s needs. 
  • CDC also has a template you can use to communicate with residents and families. 

Information reported to residents, their representatives, and families must: 

  • Not include personally identifiable information; 
  • Include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations of the facility will be altered; and 
  • Include any cumulative updates for residents, their representatives, and families at least weekly or by 5pm next calendar day following: 
    • Each time a confirmed infection of COVID-19 is identified; 

-OR- 

    • Whenever 3 or more residents or staff with new onset of respiratory symptoms occur within 72 hours of each other. 

CMS requires NHSN reporting 

(last reviewed May 23, 2020)

Per CMS memos on April 19th and May 6th, CMS will require Medicare and Medicaid-participating nursing homes to report to CDC through the National Healthcare Safety Network (NHSN). 

The NHSN Long-Term Care Facility COVID-19 Module is available, and CMS COVID-19 reporting requirements for LTCFs can be found here. Facilities should immediately gain access to the NHSN system and visit the LTCF COVID-19 module for important information, including how to register.

The following provides an overview of the registration process: 

  • Confirmed and suspected COVID-19 infections (in both residents and staff), including residents previously treated for COVID-19; 
  • Total deaths and COVID-19 deaths (both residents and staff); 
  • PPE and hand hygiene supplies in the facility; 
  • Ventilator capacity and supplies in the facility;
  • Resident beds and census; 
  • Access to COVID-19 testing while the resident is in the facility; 
  • Staffing shortages; 
  • Other information as specified by the Secretary; 
  • Facilities must submit the data through the NHSN at least once every seven days. 
  • Facilities may choose to submit multiple times a week. 
  • The deadline for facilities to submit their first set of data was 11:59 p.m. Sunday, May 17, 2020 through NHSN. 
    • CMS will provide facilities with an initial two-week grace period to begin reporting cases in the NHSN system (which ends at 11:59 p.m. on May 24, 2020). 
    • Facilities that fail to begin reporting after the third week (by 11:59 p.m. on May 31st) will receive a warning letter reminding them to begin reporting the required information to CDC.
  • Additional information, including how to access NHSN and the CMS COVID-19 Focused Survey for Nursing homes is available at the NHSN’s LTCF Covid-19 Module
  • See reporting requirements for more details.

Coordinate Testing with County Health Officials

Contact the Pima County Health Department to coordinate testing. With increased test availability and prioritization of LTCFs, facilities will be able to test all residents and staff at regular intervals, an as needed to control transmission. Staff will help assess the situation, arrange for collection of a nasopharyngeal (NP) swab or nasal wash for COVID-19 and provide guidance for further actions. Use Standard, Contact, and Droplet precautions with eye protection for specimen collection.

Upon identification of a positive COVID-19 laboratory test:

  • Immediately report laboratory positive COVID-19 cases to the Pima County Health Department by submitting this form. Your staff, residents, and residents’ families/guardians should also be notified.
  • Have ​staff​ wear all recommended PPE (i.e. standard, contact, and droplet precautions with eye protection) for all resident care, regardless of the presence of symptoms.
  • Cohort COVID-19 positive residents by room or isolate to a private room with a bathroom (10 days from specimen collection OR until 3 days (72 hours) after fever is gone (without the use of fever-reducing medication) and symptoms of acute infection resolve, whichever is longer).
  • Identify dedicated staff to care for COVID-19 positive residents and provide infection control training.
  • Perform appropriate monitoring of ill residents (including documentation of oxygen saturation via pulse oximetry) at least 3 times daily to quickly identify residents who require a higher level of care.
  • Develop criteria for closing units or the facility to new admissions.
  • Create a plan for cohorting residents with symptoms of respiratory infection, including dedicating staff to work only on specific units.

Universal Testing

Purpose:

The Pima County Health Department may provide test kits to your facility for a point prevalence survey (i.e., universal testing) of staff and residents. Think of this as a “snapshot” of COVID-19 at a point in time at your facility. This is especially important in LTCFs, where asymptomatic and pre-symptomatic residents and staff can go undetected and spread COVID-19. Note that this point prevalence testing should not replace your day-to-day protocols for testing residents and staff with suspected COVID-19 due to new onset of symptoms.

What to Expect:

Test kits will arrive with instructions for ensuring that the individuals collecting samples are adequately trained and using correct PPE.

Who to test:

Provide voluntary onsite testing for all staff and residents who have not previously tested positive for COVID-19. Test those who have never been tested or who have previously tested negative.

Who not to test:

Do not test the following individuals:
  • Staff or residents who refuse testing (this is 100% voluntary!)
  • Staff who are currently isolating or quarantining at home following PCR-confirmed COVID-19 (onsite testing only)
  • Staff who have returned to work after completing home isolation/quarantine for PCR-confirmed COVID-19 after meeting symptom-based or time-based criteria for returning to work
  • Residents who are currently on isolation for PCR-confirmed COVID-19
  • Residents with previous PCR-confirmed COVID-19 who have been removed from isolation after meeting symptom-based or time-based criteria
Not testing those who have previously tested positive will: 1) not needlessly expose the sample collector if staff/resident is currently infectious; and 2) not keep staff or residents in isolation/quarantine longer than necessary, knowing that PCR-positivity can persist long after period of infectiousness is over. This is also the most conservative approach to PPE use.

What comes next?

The state of Arizona will be supporting additional testing in long-term care in the coming weeks. Pima County health officials are working closely with ADHS to coordinate state testing efforts with ongoing county efforts. Depending on COVID-19 at your facility, the county could recommend testing all staff and residents, or staff only, at repeated intervals.

Recommendations for conducting swabbing

From CDC “Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes” (Accessed May 25, 2020)

Consider if self-collection is appropriate

  • PPE use can be minimized through self-collection while staff remain at least 6 feet away from the individual being swabbed.
  • The individual must be able to correctly self-swab and place the swab in transport media or a sterile transport device and seal.
    • If the individual needs assistance, assistance can be provided by placing the swab into transport media or a sterile transport device and sealing it for them.
  • If bulk-packaged swabs are used for sample collection, care must be exercised to avoid contamination of any of the swabs in the bulk-packaged container.

Location of specimen collection for nursing home residents

  • Specimen collection should be performed one at a time in each resident’s room with the door closed. 
  • An airborne infection isolation room is not required. 
  • Ideally for rooms with multiple residents, specimen collection should be performed one individual at a time in a room with the door closed and no other individuals present.

Location of specimen collection for staff

  • Ideally, specimen collection should be performed one individual at a time in a room with the door closed and no other individuals present. If individual rooms are not available, other options include:
    • Large spaces (e.g., gymnasiums) where sufficient space can be maintained between swabbing stations (e.g., greater than 6 feet apart).
    • An outdoor location, weather permitting, where other individuals will not come near the specimen collection activity.
  • Considerations for multiple HCP being swabbed in succession in a single room:
    • Consider the use of portable HEPA filters to increase air exchanges and to expedite removing infectious particles.
    • Minimize the amount of time the HCP will spend in the room. HCP awaiting swabbing should not wait in the room where swabbing is being done. Those swabbed should have a face mask or cloth cover in place for source control throughout the process, only removing it during swabbing.
  • Minimize the equipment kept in the specimen collection area. Consider having each person bring their own prefilled specimen bag containing a swab and labeled sterile viral transport media container into the testing area from the check-in area.

PPE for swabbing

  • HCP in the room or specimen collection area should wear an N95 or higher-level respirator (or facemask if a respirator is not available) and eye protection. A single pair of gloves and a gown should also be worn for specimen collection or if contact with contaminated surfaces is anticipated.
    • If respirators are not readily available, they should be prioritized for other procedures at higher risk for producing infectious aerosols (e.g., intubation), instead of for collecting nasopharyngeal specimens.
  • Extended use of respirators (or facemasks) and eye protection is permitted. However, care must be taken to avoid touching the necessary face and eye protection. If extended use equipment becomes damaged, soiled, or hard to breathe or see through, it should be replaced. Hand hygiene should be performed before and after manipulating PPE.
  • Gloves should be changed and hand hygiene performed between each person being swabbed.
  • Gowns should be changed when there is more than minimal contact with the person or their environment. The same gown may be worn for swabbing more than one person provided the HCP collecting the test minimizes contact with the person being swabbed. Gowns should be changed if they become soiled.
  • Consider having an observer who does not engage in specimen collection but monitors for breaches in PPE use throughout the specimen collection process.
  • HCP who are handling specimens, but are not directly involved in collection (e.g., self-collection) and not working within 6 feet of the individual being tested, should follow Standard Precautions; gloves are recommended, as well as a facemask for source control. 

Cleaning and disinfection between individuals

  • Surfaces within 6 feet of where specimen collection was performed should be cleaned and disinfected using an Environmental Protection Agency-registered disinfectant from List N if visibly soiled and at least hourly.


See Interim Testing Guidance in Response to Suspected or Confirmed COVID-19 in Nursing Home Residents and Healthcare Personnel for further details.

Environmental Infection Control

From CDC Infection Control Recommendations: Implement Environmental Infection Control (accessed May 27, 2020)

  • Dedicated medical equipment should be used when caring for residents with known or suspected COVID-19.
    • All non-dedicated, non-disposable medical equipment used for resident care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • 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 SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol generating procedures are performed.
    • Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
  • Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.
  • Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control FAQs for COVID-19

Environmental and Equipment Cleaning Resources

Considerations for Specific Communal Rooms in Your Facility

From COVID-19 Guidance for Shared or Congregate Housing (Accessed June 1, 2020)

Shared kitchens and dining rooms

  • Restrict the number of people allowed in the kitchen and dining room at one time so that everyone can stay at least 6 feet (2 meters) apart from one another.
    • People who are sick, their roommates, and those who have higher risk of severe illness from COVID-19 should eat or be fed in their room, if possible.
  • Do not share dishes, drinking glasses, cups, or eating utensils. Non-disposable food service items used should be handled with gloves and washed with dish soap and hot water or in a dishwasher. Wash hands after handling used food service items.
  • Use gloves when removing garbage bags and handling and disposing of trash. Wash hands

Laundry rooms

  • Maintain access and adequate supplies to laundry facilities to help prevent spread of COVID-19.
  • Restrict the number of people allowed in laundry rooms at one time to ensure everyone can stay at least 6 feet (2 meters) apart.
  • Provide disposable gloves, soap for washing hands, and household cleaners and EPA-registered disinfectants for residents and staff to clean and disinfect buttons, knobs, and handles of laundry machines, laundry baskets, and shared laundry items.
  • Post guidelines for doing laundry such as washing instructions and handling of dirty laundry.

Recreational areas such as activity rooms and exercise rooms

  • Consider closing activity rooms or restricting the number of people allowed in at one time to ensure everyone can stay at least 6 feet (2 meters) apart.
  • Consider closing exercise rooms.
  • Activities and sports (e.g., ping pong, basketball, chess) that require close contact are not recommended.

Pools and hot tubs

  • Consider closing pools and hot tubs or limiting access to pools for essential activities only, such as water therapy.
    • While proper operation, maintenance, and disinfection (with chlorine or bromine) should kill COVID-19 in pools and hot tubs, they may become crowded and could easily exceed recommended guidance for gatherings. It can also be challenging to keep surfaces clean and disinfected.
    • Considerations for shared spaces (maintaining physical distance and cleaning and disinfecting surfaces) should be addressed for the pool and hot tub area and in locker rooms if they remain open.

Shared bathrooms

  • Shared bathrooms should be cleaned regularly using EPA-registered disinfectants at least twice per day (e.g., in the morning and evening or after times of heavy use).
  • Make sure bathrooms are continuously stocked with soap and paper towels or automated hand dryers. Hand sanitizer could also be made available.
  • Make sure trash cans are emptied regularly.
  • Provide information on how to wash hands properly. Hang signs in bathrooms.
  • Residents should be instructed that sinks could be an infection source and should avoid placing toothbrushes directly on counter surfaces. Totes could also be used for personal items to limit their contact with other surfaces in the bathroom.

Overview of Testing for SARS-CoV-2

From CDC “Overview of Testing for SARS-CoV-2” (Accessed June 18, 2020)

Recommendations for Viral Testing, Specimen Collection, and Reporting
  • Authorized assays for viral testing include those that detect SARS-CoV-2 nucleic acid or antigen. 
  • Viral (nucleic acid or antigen) tests check samples from the respiratory system (such as nasal swabs) and identify if an infection with SARS-CoV-2, the virus that causes COVID-19, is present. 
  • Viral tests are recommended to diagnose acute infection. 
  • Some tests are point-of-care tests, meaning results may be available at the testing site in less than an hour. 
  • Other tests must be sent to a laboratory to analyze, a process that may take 1-2 days once received by the lab. 
  • Testing the same individual more than once in a 24-hour period is not recommended.
  • For more information on diagnostic testing for COVID-19 see the Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens and Biosafety FAQs for handling and processing specimens from possible cases.

Recommendations for Antibody Testing
  • CDC does not currently recommend using antibody testing as the sole basis for diagnosis of acute infection, and antibody tests are not authorized by FDA for such diagnostic purposes. 
  • In certain situations, serologic assays may be used to support clinical assessment of persons who present late in their illnesses when used in conjunction with viral detection tests.  
  • In addition, if a person is suspected to have post-infectious syndrome (e.g., Multisystem Inflammatory Syndrome in Children) caused by SARS-CoV-2 infection, serologic assays may be used.
  • Serologic assays for SARS-CoV-2, now broadly available, can play an important role in understanding the transmission dynamic of the virus in the general population and identifying groups at higher risk for infection. 
  • Unlike viral direct detection methods, such as nucleic acid amplification or antigen detection tests that can detect acutely infected persons, antibody tests help determine whether the individual being tested was previously infected—even if that person never showed symptoms.
  • It is currently not clear whether a positive serologic test indicates immunity against SARS-CoV-2;
  • As additional data are collected to understand the significance of the presence or level of antibodies and their correlation with immunity, serologic tests may have utility in infection control decisions, but for now this evidence is not available.
  • These tests can help determine the proportion of a population previously infected with SARS-CoV-2. Thus, demographic and geographic patterns of serologic test results can help determine which communities may have experienced a higher infection rate.
Categories for SARS-CoV-2 Testing
CDC has specific recommendations for five categories of people for SARS-CoV-2 testing with viral tests (i.e., nucleic acid or antigen tests):
Viral Testing of Healthcare Personnel for SARS-CoV-2
From CDC “Testing Guidelines for Nursing Homes” (Updated June 13, 2020)
  • At the start of each shift, take the temperature of all HCP and ask about the presence of COVID-19 symptoms; perform viral testing of any HCP who have signs or symptoms of COVID-19.
  • Perform initial viral testing of all HCP, along with weekly viral testing thereafter, as part of the recommended reopening process
  • HCP who test positive for SARS-CoV-2 should be excluded from work until they meet return to work criteria.
Viral Testing of Residents for SARS-CoV-2
From CDC “Testing Guidelines for Nursing Homes” (Updated June 13, 2020)
  • Perform initial viral testing of each resident in a nursing home, as part of the recommended reopening process.
    • Initial viral testing of each resident in any nursing home (who are not known to have previously been diagnosed with COVID-19) is recommended because of the high likelihood of exposure during a pandemic, transmissibility of SARS-CoV-2, and the risk of complications among residents following infection. The results of viral testing inform care decisions, infection control interventions, and placement decisions (e.g., cohorting decisions) relevant to that resident.
  • At least daily, take the temperature of all residents and ask them about presence of COVID-19 symptoms; perform viral testing of any residents who have signs or symptoms of COVID-19.
    • Clinicians should use their judgment to determine if a resident has signs or symptoms consistent with COVID-19 and whether the resident should be tested. Most people with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough). Some people may present with only mild symptoms or other symptoms as well.
    • Clinicians are encouraged to consider testing for other causes of respiratory illness, such as influenza, in addition to testing for SARS-CoV-2.
    • Facility leadership and local and state health departments should have a plan for performing contact tracing for close contacts of residents with SARS-CoV-2 infection.
Viral Testing in Response to an Outbreak
  • Initial Viral Testing in Response to an Outbreak
    • Perform expanded viral testing of all residents and HCP in the nursing home if there is an outbreak in the facility (i.e., a new SARS-CoV-2 infection in any HCP, or any nursing home-onset SARS-CoV-2 infection in a resident).
    • A single new case of SARS-CoV-2 infection in any HCP or a nursing home-onset SARS-CoV-2 infection in a resident should be considered an outbreak. When one case is detected in a nursing home, there are often other residents and HCP who are infected with SARS-CoV-2 who can continue to spread the infection, even if they are asymptomatic. Performing viral testing of all residents and HCP as soon as there is a new confirmed case in the facility will identify infected individuals quickly to assist in their clinical management and allow rapid implementation of IPC interventions (e.g., isolation, cohorting, use of personal protective equipment) to prevent SARS-CoV-2 transmission. When undertaking facility-wide viral testing, facility leadership should expect to identify multiple asymptomatic and pre-symptomatic residents and HCP with SARS-CoV-2 infection and be prepared to cohort residents and mitigate potential staffing shortages. See Public Health Response to COVID-19 in Nursing Homes and Strategies to Mitigate Healthcare Personnel Staffing Shortages for more detail.
    • If viral testing capacity is limited, CDC suggests first directing testing to residents and HCP who are close contacts (e.g., on the same unit or floor of a new confirmed case).
    • See Considerations for Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes for additional details.
  • Repeat Viral Testing in Response to an Outbreak
    • After initially performing viral testing of all residents and HCP in response to a new case, CDC recommends repeat testing to ensure there are no new infections among residents and HCP, and that transmission has been terminated as described below.  Repeat testing should be coordinated with the local, territorial, or State health department.
    • Immediately perform viral testing of any resident or HCP who subsequently develops signs or symptoms consistent with COVID-19.
    • Continue repeat viral testing of all previously negative residents, generally between every 3 days to 7 days, until the testing identifies no new cases of SARS-CoV-2 infection among residents or HCP for a period of at least 14 days since the most recent positive result. This follow-up viral testing can assist in the clinical management of infected individuals and in the implementation of infection control interventions to prevent SARS-CoV-2 transmission.
    • If viral test capacity is limited, CDC suggests directing repeat rounds of testing to residents who leave and return to the facility (e.g., for outpatient dialysis) or have known exposure to a case (e.g., roommates of cases or those cared for by a HCP with confirmed SARS-CoV-2 infection). For large facilities with limited viral test capacity, testing all residents on affected units could be considered, especially if facility-wide repeat viral testing demonstrates no transmission beyond a limited number of units.
    • Continue repeat viral testing of all previously negative HCP, generally between every 3 to 7 days, until the testing identifies no new cases of SARS-CoV-2 infection among residents or HCP for a period of at least 14 days since the most recent positive result.
    • If testing capacity is limited, CDC suggests directing repeat HCP testing to HCP who work at the current facility and also work at other facilities where there are known cases of SARS-CoV-2 infection.

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