Guidance for Infection Control and Prevention of COVID-19 in Nursing Homes REVISED Again

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

In response to President Trump’s declaration of a national state of emergency Friday afternoon, March 13, 2020, CMS has again revised and updated QSO-20-14-NH…Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes.

Included in this guidance is that ALL facilities nationwide “should restrict visitation of all visitors and non-essential health care personnel, except for certain compassionate care situations, such as an end-of-life situation.  In those cases, visitors will be limited to a specific room only.  Facilities are expected to notify potential visitors to defer visitation until further notice (through signage, calls, letters, etc.).”

Additional guidances include:

  • Cancel communal dining and all group activities, such as internal and external group activities.
  • Implement active screening of residents and staff for fever and respiratory symptoms.
  • Remind residents to practice social distancing and perform frequent hand hygiene.
  • Screen all staff at the beginning of their shift for fever and respiratory symptoms. Actively take their temperature and document absence of shortness of breath, new or change in cough or sore throat.  If they are ill, have them put on a facemask and self-isolate at home.
  • Facilities should communicate through multiple means to inform individuals and non-essential health care personnel of the visitation restrictions, such as through signage at entrances/exits, letters, emails, phone calls, and recorded messages for receiving calls.
  • Facilities should identify staff that work at multiple facilities (e.g., agency staff, regional or corporate staff, etc.) and actively screen and restrict them appropriately to ensure they do not place individuals in the facility at risk for COVID-19.
  • Advise visitors, and any individuals who entered the facility (e.g., hospice staff), to monitor for signs and symptoms of respiratory infection for at least 14 days after exiting the facility. If symptoms occur, advise them to self-isolate at home, contact their healthcare provider, and immediately notify the facility of the date they were in the facility, the individuals they were in contact with, and the locations within the facility they visited.  Facilities should immediately screen the individuals of reported contact, and take all necessary actions based on findings.

The guidance provides answers to these questions:

  • When should nursing homes consider transferring a resident with suspected or confirmed infection with COVID-19 to a hospital?
  • When should a nursing home accept a resident who was diagnosed with COVID-19 from a hospital?
  • Will nursing homes be cited for not having appropriate supplies?
  • What other resources are available for facilities to help improve infection control and prevention?

PLEASE review and share this guidance with your team and all staff members IMMEDIATELY.  There is more information within the QSO that I’ve excerpted above that you need to be aware of – in particular exceptions to restriction and compassionate care visitation requirements.

While this QSO’s title is Nursing Homes, I would encourage Assisted Living facilities and other communal senior living housing to consider its guidance as well.

Be safe and protect your residents, staff and visitors.

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