Health Alert:   COVID-19 Community Level:   HIGH   More information

Guía para instalaciones de cuidados a largo plazo

Actualizaciones y cambios recientes a la guía

  1. La guía actual de los CDC asupone que todo el personal está potencialmente expuesto y que el personal debe practicar el control universal de fuentes de infecciones. Ya no se recomienda que las instalaciones de atención médica evalúen la exposición del personal a través del rastreo de contactos y la detección de fiebre y síntomas de COVID-19 antes de cada turno. Se encuentran disponibles más detalles sobre el control universal de fuentes en entornos de atención médica..

  2. Se emitieron órdenes ejecutivas de la Oficina del Gobernador Doug Ducey para

    1. fortalecer la protección en los centros residenciales y centros de cuidados exigiendo la notificación de casos positivos de COVID-19 dentro de los asilos.

    2. extender ciertas licencias profesionales que expiran entre el 1 de marzo de 2020 y el 1 de septiembre de 2020 y diferir los requisitos de educación continua.

    3. extender las protecciones del Buen Samaritano para los trabajadores de primera línea que responden a la pandemia de COVID-19.

  3. 2-1-1 Arizona lanzó una línea directa COVID-19 en todo el estado que ofrece un punto de entrada para responder a las preguntas e inquietudes de los residentes de Arizona sobre COVID-19.


  4. El Departamento de Servicios de Salud de Arizona (ADHS por sus siglas en inglés) tiene una línea centralizada de llamadas de 24/7 para la transferencia de instalación-a-instalación de residentes hacia/desde hospitales y asilos.

    • Este sistema gestionará el rendimiento y evitará los embotellamientos en el departamento de emergencias (ED) con cuatro componentes claves: 
    • Acelerar la transferencia de residentes a un nivel superior de atención.
    • Acelerar la transferencia de residentes a un nivel inferior de atención.
    • Proporcionar una red de seguridad para el transporte entre instalaciones
    • Brindar consultas de cuidados críticos y cuidados paliativos azhealth.gov/surgeline 1.877.SURGE.AZ (1.877.787.4329)
    • Incluso con la implementación de la "Fase I Regresando más fuerte" de Arizona y la reapertura gradual de ciertos negocios, las restricciones de visitas en las instalaciones de cuidados a largo plazo deben permanecer vigentes para todos, excepto los proveedores de cuidados médicos esenciales. La reapertura de la Fase I tiene el potencial de aumentar la transmisión en las comunidades, lo que significa más oportunidades para la introducción de COVID-19 dentro de las instalaciones.


Prevenir la entrada de COVID-19 en sus instalaciones es fundamental.

  • Restrinja a los visitantes según la guía de restricción de visitantes de ADHS, con posibles exenciones para algunas visitas de atención compasiva (final de la vida). Haga un inventario y evalúe qué voluntarios, personal y servicios de consultores (peluqueros, etc.) son esenciales, y restrinja la entrada de todo el personal no esencial.
    • Envíe cartas o correos electrónicos a las familias (plantilla ejemplar) advirtiéndoles que no se permitirán visitas en la instalación, excepto en ciertas situaciones de cuidado compasivo, como las situaciones de final de vida.
    • El establecimiento debe facilitar el uso de métodos alternativos para las visitas (por ejemplo, videoconferencia).
  • Educar a todos los residentes sobre la prevención de virus respiratorios, incluyendo COVID-19.
    • Asegure que la educación incluya lavado básico de manos e higiene respiratoria.
    • Hacer cumplir el distanciamiento físico (al menos 6 pies – 2 metros) entre los residentes.
    • Asegúrese de que los residentes estén al día con las vacunas, incluida su vacuna contra la influenza estacional.
  • Solicite a los residentes que informen y evalúen sus síntomas.
  • Explique las acciones que la instalación está tomando para protegerlos.
  • Cancele todas las actividades grupales, comidas comunitarias y viajes no médicamente necesarios fuera de las instalaciones.
  • Los residentes deben usar una máscara facial o una cubierta de tela para la cara (si se tolera) o usar pañuelos para cubrirse la boca y la nariz al salir de la habitación con fines médicamente necesarios y cuando el personal esté en su habitación.
  • Actively screen staff, residents, visitors, or anyone for fever and symptoms of COVID-19. Staff should be screened before starting their shift.
  • Ensure non-punitive sick-leave and require employees to stay home if they’re sick.
  • Cancel all group activities and communal dining.
  • Everyone, including residents, staff, and visitors should wear a mask or cloth face covering (not including first responders responding to emergency call).
  • Assess Cleanliness and Access to Hand Hygiene
    • Ensure access to alcohol based hand sanitizer, with 60–95% alcohol, inside and outside every resident room.
    • Ensure access to alcohol based hand sanitizer in other resident care and common areas (e.g., outside dining hall, therapy gym).
    • Make sure that sinks are well stocked with soap and paper towels for handwashing.
    • Make tissues and facemasks available to residents and staff.
    • Ensure proper cleaning of environmental surfaces.

Staff

  • Educate all staff on the prevention of respiratory viruses, including COVID-19, including proper hand washing, respiratory hygiene, and implementation of Standard, Contact, and Droplet precautions with eye protection.
  • Ensure ​training​ and adherence to proper ​donning and doffing of PPE.
  • Consider a dedicated donning/doffing observer to monitor, protect, and guide health care providers through the protocols of donning and doffing PPE.
  • Instruct staff to practice physical distancing (maintain a distance of at least 6 feet from others) when in break rooms or common areas.
  • Governor’s Executive Order 2020-36 “promotes physical distancing” and states that “all individuals, when in public areas should maximize physical distance from others. Social settings where appropriate physical distancing is not practical should be avoided unless precautionary measures are observed and CDC guidelines are followed.” This applies to areas off-site and away from long-term care or assisted living facilities.
  • Governor’s Executive Order 2020-36 also states that “members of households with vulnerable individuals should take precautions to protect individuals and should be aware that by returning to work or being out in public, they could carry the virus back home.”
  • If employees develop any symptoms consistent with COVID-19* they must
    • Cease contact with residents. 
    • Notify their supervisor or occupational health services prior to leaving work. 
    • Staff with suspected COVID-19 should be prioritized for testing.
    • ADHS employee-specific guidance is available under the COVID-19 Exposure Guidance for Providers and Healthcare Workers tab. 

Residents

  • Actively screen all residents, at least daily, and at time of admission, for fever and respiratory symptoms.
    • Residents may not show typical symptoms, fever may be absent.
    • Implement a tracking system for ill residents. 
    • Immediately isolate residents who are symptomatic.
    • Coordinate offsite medical appointments with the offsite medical facility to avoid potential spread of COVID-19.
    • Residents will have potential COVID-19 exposure when returning from any off-site locations, including dialysis facilities, and should be quarantined in their rooms using COVID-19 isolation precautions for 14 days after admission or readmission to a long-term care facility from an acute care facility. 
    • Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
  • Educate all residents on the prevention of respiratory viruses, including COVID-19.
    • Ensure education includes basic hand washing and respiratory hygiene.
    • Enforce physical distancing (at least 6 feet) between residents.
    • Ensure residents are up-to-date on vaccinations, including their seasonal influenza vaccination.
  • Ask residents to report and assess for symptoms.
  • Explain actions the facility is taking to protect them.
  • Cancel all group activities, communal dining, and non-medically necessary trips outside of the facility.
  • Residents should wear a facemask or cloth face covering (if tolerated) or use tissues to cover their mouth and nose when leaving the room for medically necessary purposes and when staff are in their room.
  • When accepting residents from hospitals or other higher acuity facilities, follow all proper guidance. Additional guidance is available from the State on accepting admissions and readmissions and LTCF Facility Guidance.
  • COVID-19 positive residents or staff are considered infectious 48 hours prior to symptom onset until fever free for at least 3 days (72 hours) without the use of medicine that reduces fevers; AND other symptoms have improved; AND at least 10 days have passed since symptom onset. Full guidance is available from the State.
  •  Following CDC universal source control guidance, staff and residents should wear a facemask or respirator at all times while they are in the facility, regardless of test results. 
  • If a resident is asymptomatic and tested negative for COVID-19 by PCR or serology: 
    • No isolation is required. Take everyday precautions to prevent the spread of COVID-19. 
    • If a resident has other non-compatible symptoms and has not been tested for COVID-19: 
      • Stay away from others or under isolation precautions until you have had no fever for at least 24 hours without the use of medicine that reduces fevers; AND other symptoms have improved. 

PPE

  • Have a system to track your PPE supply. 
  • Monitor daily PPE use to identify when supplies will run low; use the PPE burn rate calculator or other tools. 
  • Implement strategies to optimize current PPE supply before shortages occur. 
  • Bundle resident care and treatment activities to minimize entries into residents’ rooms (e.g., having clinical staff clean and disinfect high-touch surfaces when in the room). 
  • Extend use of respirators, surgical facemasks, and eye protection, which refers to the practice of wearing the same respirator or surgical facemask and eye protection for the care of more than one resident (e.g., for an entire shift).  
  • Develop a process for decontamination and reuse of PPE such as face shields and goggles. 
  • Make necessary PPE available in areas where resident care is provided. 
  • Post signs on the door or wall outside of the resident room that clearly describe the type of precautions needed and required PPE. 
  • Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE. 
  • Encourage staff to review appropriate donning and doffing of PPE outlined.

Gowns

In the event that no gowns are available, the CDC lists alternative clothing options that can be considered as a last resort for care of COVID-19 residents as single use. However, none of these options can be considered PPE, since their capability to protect HCP is unknown. Preferable features include long sleeves and closures (snaps, buttons) that can be fastened and secured.

Mental Health

See CDC guidance for coping with stress and taking care of your emotional health

  • Please consider the mental health of your residents and when implementing isolation precautions and recommendations. 
  • Doctors may be more likely to miss mental health concerns among:

Universal testing (tab)
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.  

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3950 S. Country Club Road
Ste. 100
Tucson, AZ 85714

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