Keeping COVID-19 Out of Facilities

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Visitors and staff are the most likely source of introduction of COVID-19 into LTCFs and can be symptomatic, asymptomatic or presymptomatic carriers of COVID-19 into your facility. For this reason, PCHD, ADHS, and CDC recommend restriction of all non-essential visitors and adherence to the following recommendations. Assume all staff and visitors are potentially exposed and practice interventions to limit the unrecognized introduction of COVID-19.

Universal Source Control 

(Guidance is aligned with CDC Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 [COVID-19] in Healthcare Settings [May 22, 2020])

  • To protect others in case of asymptomatic or pre-symptomatic transmission, practice “universal source control,” meaning everyone entering the facility should wear a mask or cloth face covering. 
  • In addition to universal source control efforts, implement a system that requires employees to attest to their wellness everyday before entering the facility. The system should inquire about COVID-19 related symptoms, although this is not enough to detect all infected individuals.
  • Check for fever, and restrict entry to anyone with documented or reported fever. 
  • Staff who work in multiple locations may pose a higher risk and should be encouraged to tell facilities if they have had exposure to other facilities with suspected or confirmed COVID-19 cases. If possible restrict staff to work in a single facility.
  • N95s with an exhaust valve do not provide source control and can release infectious respiratory droplets into the facility because the wearer exhales through the valve.

Restrict all visitation and non-essential services

  • Except for certain compassionate care situations, such as end of life situations, all visitation should remain restricted. Decisions about visitation during an end of life situation should be made on a case-by-case basis. These visitors should be screened for symptoms consistent with COVID-19 and wear a mask. Those with symptoms should not be permitted to enter the facility.
  • Do not allow entry of non-essential personnel (e.g., barbers, consultants). 
  • Ensure sick leave policies are non-punitive and allow employees to stay home if they have symptoms consistent with COVID-19 or other signs of illness. 

ADHS visitor restriction guidance

  • Aligned with ADHS Long-term Care Facility Guidance (Accessed May 14, 2020):
  • Because of the ease of spread in a LTCF setting and the severity of illness that occurs in residents with COVID-19, facilities should restrict visitation. Please see the Emergency Rules for Disease Prevention and Control (A.A.C. R9-10-121).
  • Restrict all visitors except for compassionate care situations (e.g., end of life). 
  • Restrict all non-essential volunteers and staff, including consultant services (e.g., barber). 
  • Send letters or emails to families advising them that all visitation is being restricted and explain possible alternative methods for visitation (e.g., video conferencing or window visits). 
  • Explain actions the facility is taking to protect them and their loved ones. 
  • Facilitate remote communication between residents and visitors (e.g., video call applications on cell phones or tablets; be sure to disinfect high-touch surfaces between uses). 
  • Post signs at the entrances to the facility instructing visitors to not enter. 
  • Anyone entering the facility should be practicing source control by wearing a facemask or cloth face covering. 
  • Screen compassionate care visitors and essential volunteers for fever and symptoms of respiratory infection. Restrict anyone with: 
  • Fever or symptoms of respiratory infection (e.g., cough, sore throat, or shortness of breath). 
  • Contact with an individual with COVID-19. 
  • Consider having visitors sign visitor logs, in case contact tracing becomes necessary. 
  • Provide instruction, before visitors enter, on hand hygiene, limiting surfaces touched, use of PPE according to current facility policy, and limit their movement and interactions with others in the facility (e.g., confine themselves to resident’s room). 
  • Advise exposed visitors (e.g., contact with COVID-19 positive resident unidentified at time of visit) to report any signs and symptoms of acute illness to their healthcare provider for a period of at least 14 days after the last known exposure to resident with COVID-19. 
  • Allow entry to only individuals who need entry. 
  • Maintain contact information for resident’s family or next of kin and continue open communication.

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. 
  • Use a bleach-and-water solution (0.1% solution; 1:50 dilution)
List N: EPA’s Registered Antimicrobial Products for Use Against Novel Coronavirus SARS-CoV-2, the Cause of COVID-19.

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