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HAMPTON MANOR INTERIM GUIDELINES AND PROTOCOL FOR COVID-19

Covid Policies;

Management of Outbreak of Communicable Diseases (COVID-19) Guideline:

Outbreaks of communicable diseases within the Hampton Manor Communities will be promptly identifies and appropriately handled. This guideline is written to provide infection prevention and control measures forresidents and staff members during the outbreak of COVID-19.

 

Fundamental Information Background:

COVID-19 is a virus strain, first identified in Wuhan, Hubei Province, China, that has only spread in peoplesince December 2019. Health experts are closely monitoring the situation because little is known about thisnew virus and it has the potential to cause severe illness and pneumonia in some people.

 

How it is spread:

COVID-19 is primarily spread through respirator droplets, which means to become infected, peoplegenerally must be within six feet of someone who is contagious and come into contact with these droplets.It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on itand then touching their own mouth, nose, or possibly their eyes. Symptoms of COVID-19 appear within 2-14 days after exposure and include fever, cough, runny nose, and difficulty breathing.

 

High Risk Residents

Based upon information available to date, those at high-risk for severe illness from COVID-19 include:

• People aged 65 years or older
• People who live in a nursing home or long-term care facility
• Other high-risk conditions could include:
  • People with chronic lung issues or moderate to severe asthma
  • People who have serious heart conditions
  • People who are immunocompromised including cancer treatment
  • People of any age with severe obesity (body mass index (BMI)>40) or certain underlyingmedical conditions, particularly if not well controlled, such as those with diabetes, renalfailure, or liver disease might also be at risk
• People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk

Many conditions can cause a person to be immunocompromised, including cancer treatment, bone marrowor organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use ofcorticosteroids and other immune weakening medications

 

Symptoms:

Reported illnesses have ranged from mild symptoms to severe illness and can lead to respiratorypneumonia, respiratory distress and death. The following symptoms may appear 2- 14 days afterexposure: new cough, fever, cough, and shortness of breath.

 

Prevention:

The best way to prevent illness is to avoid being exposed to this virus. However, the CDC recommendseveryday preventive actions to help inhibit the spread of respiratory diseases, including:

• Avoid close contact with people who are sick
• Avoid touching your eyes, nose, and mouth
• Stay home when you are sick
• Until more is known about how COVID-19 spreads, The CDC and OSHA recommend using acombination of standard precautions, contact precautions, airborne precautions, and eye protection(face shield or goggles) to protect residents and healthcare works with exposure to the
• Cover your sneeze or cough with our arm or a tissue, then throw away the tissue and wash yourhands
• Clean and disinfect frequently touched objects and surfaces using disinfectant spray or
• Follow CDC’s recommendations for using a facemask
  • Facemasks should be used by all health care personnel who are in contact with patients to help prevent the spread of the disease to others. The use of facemasks is also crucial forhealth workers and people who are taking care of someone in close settings (at home or in ahealth care facility)
  • https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-html
  • For more information, please see https://www.cdc.gov/coronavirus/2019-ncov/downloads/hcp-preparedness-checklist.pdf
• Wash your hands often with soap and water for at least 20 seconds, before and after entering aresident’s room, especially after going to the bathroom; before eating; and after blowing yournose, coughing, or
  • If soap and water are not readily available, use an alcohol-based hand Always washhands with soap and water if hands are visibly dirty.
• Monitor visitors though a surveillance questionnaire, limiting visitations and encouraging alternativevisiting methods such as telephone, skype, text and email and not permitting symptomatic people to
• Housekeeping teams will increase cleaning and disinfecting of common

 

Procedure

1. When a potential outbreak of a communicable disease arises, the Infection Preventions and Control Nurse should take aggressive steps to contain the disease and prevent
2. The Health Department should be notified immediately of any suspected cases of COVID-19or notification of exposure to the
3. Contacts are to be cultured as directed by the health department, staff nurse, and/or attendingphysician(s) (If applicable). The health department should provide contact information regardinghow to obtain test
4. Symptomatic residents and employees are to be considered potentially infected and are to be
5. Administration will be responsible for:
   • Telephoning report to health department
   • Activating Emergency Preparedness Procedures
   • Submitting daily progress reports to the health department
   • Calling emergency meetings of the Infection Prevention and Control Committee
   • Discontinuing group activities, as indicated
   • Limiting visitors
   • Screening visitors and employees (COVID 19 Screening Tool)
   • Forwarding Communicable Disease Report Cards to the health department
6. The Director of Nursing and/or Infection Preventionist services will be responsible for:
   • Contact Clinician
   • Receiving surveillance information and tabulating data
   • Maintaining line listing or identified cases
   • Notifying the medical director and the attending physician
   • Assigning nursing personnel to same residents’ groups for the duration of the outbreak

• Directing teams to follow protocols to reduce the risk of spreading the disease
• If having difficulty obtaining PPE (down to 1 week with no availability for restock) you shouldcontact your Regional Healthcare Coalition as they are coordinating the stocks of PPE supplies and have developed a prioritization flowchart for

7. The nursing staff will be responsible for:
   • Monitoring residents and other team members for symptoms of
   • Notifying the Director of Nursing, Infection Preventionist and physician (if applicable) ofsymptomatic residents
   • Providing infection surveillance data in a timely manner
   • Obtaining laboratory specimens as directed
   • Initiating isolation barriers as directed or necessary
     • If a current resident begins to show signs/symptoms and COVID-19 is suspected,precautions should be taken, and notifications made to the local health departmentas well as the If test comes back

positive or the resident’s condition deteriorates, you will likely be advised

to transfer to the designated COVID-19 area.

• Use masks for anyone who is or has been exposed
• Confining symptomatic residents to their rooms
• Managing and monitoring resident conditions and reporting updates to the physician
• Follow standard precaution protocols when handling soiled waste

8. It is the responsibility of all employees to:
   • Practice good hygiene and good hand washing
   • Report illness to their supervisor
   • Follow infection control guideline as outlines in the community protocols
   • Report to work as schedules unless under sick criteria or underlying conditions

 

Quick Reference Guide

General Measures:

• Restrict all visitors unless it is an end of life situation – Governor Whitmer issued Executiveorder 2020-108 (rescinded from order 2020-07) placing restrictions on visitation
• Screen all individuals when entering the building – this includes screening all staff at the onset of their Executive order 2020-108 (rescinded from order 2020-07)
• Post signs at entrances to let potential visitors know they may not enter the building

Executive order 2020-108 (rescinded from order 2020-07)

• Identify ways to assist residents stay in touch with their loved ones, including FaceTime, Skype, orother remote methods
• Screen residents on a daily basis for signs and symptoms of COVID-19, including fever, new orchanged cough, or shortness of breath Executive order 2020-123
• Place hand sanitizer in rooms and public and common areas around community

Executive order 2020-123

• Ensure wash stations are adequately stocked with soap and paper towel Executive order 2020-123
• Reinforce hand hygiene and general infection prevention principles with staff as applicableExecutive order 2020-123

Symptomatic Resident Identified:

• Isolate the individual into the designated area for residents with symptoms to avoid potential crosscontamination with other residents
• Implement contact safety precautions
• Notify Nurse and/or physician
• Contact the local health department to report symptoms
• Contact the resident/responsible party
• In combination with the Nurse/ Physician (if applicable) and the local health department,determine the need for testing and make arrangements if necessary
• If necessary, complete and submit to the local health department the CDC’s patient

under investigation form

• Increase resident monitoring and signs and symptoms or change in condition to once per shift

 

Resident Tests Positive:

• Begin any steps for Symptomatic Resident above that have not already been implemented
• Increase resident monitoring for signs and symptoms or change in condition to twice per shift
• Contact the local health department, community nurse, community physician (if applicable),and resident/responsible party of the results
• Identify staff members who have had close contact with the resident(s), identifying for 5 days prior tothe onset of symptoms if possible
  • Mask these individuals
  • Monitor for onset of signs and symptoms
• Identify any outside contact such as lab, home health care, PT, hospice, and notify of the need toimplement further monitoring and precautions
• Implement a communication plan to staff and families to ensure they are aware of all measures thecommunity has
• Notify the survey consultant of a positive case in the community as a courtesy
• Manage in place if the resident’s symptoms can be treated on-site
• Transfer resident to hospital if their condition worsens and requires a higher level of care than thecommunity can

 

Staff Present with Positive Symptoms or Positive Test:

• If a staff member presents with fever, new or changed cough or new onset shortness of breath theyshould be masked and sent home
• Advise they contact their primary care provider and discuss testing and treatment. Advise staff tocall their provider rather than showing up at the office to avoid the possibility of transmission
• Staff may return to work following the CDC Guidance for Return to Work criteria

 

Staff Working During the Crisis

Due to sustained widespread community transmission in multiple areas of the State, MDHHS has releasednew Guidance for Healthcare Worker Self-Monitoring and Work Restriction in the Presence of SustainedCommunity Transmission of Coronavirus Disease 2019 (COVID-19). This attached guidance is intended tohelp with development of occupational health programs, policies, and priorities for groups that are critical tothe healthcare system in the State of Michigan. The primary recommendations in this guidance include:

1. If you are sick, please stay
2. Hampton Manor employees currently prohibited from working because of previous direction may return to work if asymptomatic and if ability to be closely monitored is available at the
3. In the context of sustained community transmission of VOCID-19, all Hampton Manor employees are atrisk for unrecognized Therefore, ALL staff should self-monitor for fever with twice-dailytemperature measurements and for symptoms consistent with COVID-19
4. If you are a Hampton Manor employee who has had a known high-risk exposure to a resident(s) withconfirmed COVID-19, even though the employee can continue to work, extra care to monitor health shouldbe There is no requirement for 14-day quarantine of employees with high-risk exposures in thesetting of sustained community.
5. MDHHS advises against testing of any asymptomatic individuals with or without an exposure to COVID-19, including healthcare
6. If any employee feels overwhelmed and is in need of support to cope with the situation, contact theSAMHSA Disaster Distress Hotline 800-985-5990.

 

Updated CDC Guidance – Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings:

The Centers for Disease Control and Prevention (CDC) recently updated Guidance – Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings, clarifying the guidance on when a hospitalpatient may be discharged to a lesser level of care. The updated guidance clarifies that patients with COVID-19 can be discharged form a healthcare facility when clinically indicated. Meeting criteria for discontinuing precautions is not a prerequisite for discharge to a long-term care facility (assisted living facility), with the decision dependent on the ability of the assisted living facility to provide the care needed for the patient.

The guidance specifically addresses discharges from the hospital to skilled nursing as below: If discharged to a long-term care or assisted living facility, AND

• Transmission-Based Precautions are still required, they should go to a facility with adequate personal protective equipment (PPE) supplies and an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed at a facility that has already cared for COVID-19 cases, in a specific unit designated to care for COVID-19 residents
• Transmission-Based Precautions have been discontinued, but the patient has persistent symptoms from COVIS-19 (e.g. persistent cough), they should be placed in a single room and be restricted to their room to the extent possible, and wear a facemask (if tolerated) during care activities until all symptoms are completely resolved or at
• Transmission-Based Precautions have been discontinued and the patient’s symptoms have resolved, they do notrequire further restrictions, based on their history of COVID-19

 

The decision to discontinue Transmission-Based Precautions should be made using a test-based strategy or a symptom-based strategy (i.e., time-since-illness-onset and time-since-recovery- strategy). Meeting criteria for discontinuation of Transmission-Based Precautions is not prerequisite for discharge.

1. Test-based strategy
   • Resolution of fever without the use of fever-reducing medications and
   • Improvement in respiratory symptoms (e.g. cough, shortness of breath), and
   • Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2RNA from at least two consecutive nasopharyngeal swab specimens collected> 24 hours apart (total of two negative specimens). See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for2019 Novel Coronavirus (2019-nCoV).
2. Symptom-based strategy
   • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g. cough, shortness of breath); and
   • At least 10 days have passed since symptoms first appeared

 

Patients with laboratory-confirmed COVID-19 who have not had any symptoms should remain in Transmission-BasedPrecautions until either:

 

• Time-based strategy
  • 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have notsubsequently developed symptoms since their positive Note, because symptoms cannot be used to gaugewhere these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test.
• Test-based strategy
  • Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 from at least 2 consecutive respiratory specimens collected >24 hours apart (total of two negative specimens). Note, because of the absence of symptoms, it is not possible to gauge where these individualsare in the course of their illness. There have been reports of prolonged detection of RNA without directcorrelation to viral

 

Consider consulting with local infectious disease experts when making decisions about discontinuing Transmission-BasedPrecautions for patients who might remain infectious longer than 10 days (e.g. severely immunocompromised).

 

 

When a Testing-Based Strategy is Preferred

 

Hospitalized patients may have longer periods of SARS-CoV-2 RNA detection compared to patients with mild or moderate disease. Severely immunocompromised patients (e.g., medical treatment with immunosuppressive drugs, bone marrow or solid organ transplant recipients, inherited immunodeficiency, poorly controlled HIV) may also have longer periods of SARS- CoV-2 RNA detection and prolonged shedding of infectious recovery. These groups may becontagious for longer than others. In addition, placing a patient in a setting where they will have close contact withindividuals at risk for severe disease warrants a conservative approach.

 

Hence, a test-based strategy is preferred for discontinuation of transmission-based precautions for patients who are:

 

• Hospitalized or
• Severely immunocompromised or
• Being transferred to a long-term care or assisted living facility

 

If testing is not readily available, facilities should use the symptom-based strategy for those with symptoms and the “time-based strategy” for those without symptoms for discontinuation of Transmission-Based Precautions or extend the period of isolation beyond the suggested duration, or on a case by cases basis and in consultation with local and statepublic health authorities.

 

At this time, we are asking you to contact the Health Department for guidance on how they want you to take people off precautions. If we get guidance in writing on how to take people off precautions, we will updatethese guideline.

 

Swabbing Residents Purpose – To provide guidance on swabbing residents for viruses. Guidance

1. Contact local lab if you need swabs
2. The universal viral swabs (Red Cap ink fluid) are used for influenza, respiratory viral panel, and theCOVID-19.
3. Each test does require a separate If you are testing for both the Flu and for COVID-19 you willneed 2 universal viral swabs.
4. Contact lab for pick up

 

Reference: Centers for Disease Control and Prevention. CDC twenty-four seven. Saving Lives, ProtectingPeople

 

COVID-19 Response Executive order2020-123

 

Purpose: To prepare team members for caring for residents with suspected or confirmed COVID-19. Toprovide direct care and services to these residents only and to provide guidelines on what to do and shouldbe done if a resident(s) is suspected or confirmed COVID-19.

 

Fundamental Information

 The elderly with multiple comorbidities, are most at risk of negative outcomes up to and including death from the COVID-19 virus. Facilities must be prepared to care for residents in place unless symptoms become too acute to manage and the resident requires transport to the hospital. The following are guidelines designed to prepare team members should a resident have a suspected or confirmed case of COVID-19 or if a resident should be admitted fromthe hospital who has tested positive.

 

Guidelines:

1. Team members should be educated on what to expect if a resident has a suspected case of COVID-19.
   1. Isolation in place with the door closed and use of PPE by team
      1. Staff members may wear same mask and eye goggles for the full 8-hour shift but should refrain from touching face, mask and goggles. Mask should be changed if wet or soiled.
   2. The same nurse, CNA, and housekeeper will be assigned to the resident(s).
   3. If an isolation wing has been designated, the resident will be transported to the isolation wing (withmask on) and will remain on the isolation wing until cleared by the health department.
   4. Team members have a choice of staying at the facility or changing clothes and washing beforereturning home each day.
   5. Team members should minimize social gatherings when caring for residents with COVID-19 and should follow meticulous hand washing and not touch face, mouth, nose and eyes as much as
2. Residents who have suspected COVID-19 should be placed on the isolation wing and the Response Team should be
3. The clinician hotline should be contacted at 888-277-9894 for a Person Under Investigation numberand for guidance on priority testing.
4. The local health department should be contacted, and guidance provided should be

 

COVID-19 Communication Plan

Guidance if get COVID-19 in the building

We need to be proactive with families to provide transparency and open

communication. Individual families should be contacted by phone for 1:1 conversation. If facetime is needed to reassure them of their family member’s well-being, please do so. If you have difficult families, please have the most diplomatic person contact them so we can do our best to help them process the information. We will be putting a noticeon the facility webpage to assure we are fully transparent, which provides reassurance and trust to the community. After you are done with contacting all families, we will post an update on your facility website. We do not want families finding out via another source. Best is to talk to them 1:1 – will help them to trust you and our care.

 

If residents have no symptoms

Contact families by phone to inform them and discuss measures we are taking:

Hi, this is                            from                           . I am calling to let you know we have our first case of a resident who tested positive COVID-19 in our facility (add while in the hospital if that is relevant). and want to reassure you that we have put measures into place to isolate anyone showing symptoms and minimize the risk to other residents including your family member. (can give an update that no residents have symptoms currently, but we are monitoring or that we are monitoring several, but they are in isolation. Specific number is not necessary). We have in place

 

• Isolation or putting residents together in a room who have tested positive or are showing symptoms
• Assigning specific team members to residents who are positive and not allowing them to care for others that havenot tested positive.
• Keeping residents in their rooms and using personal protective equipment under the guidance of the
• Monitoring all residents for symptoms daily

 

We are in contact with the health department and are working closely with them and our community nurse and community doctor (if applicable) to address the situation. We have prepared for this and are taking all measurespossible to keep our resident protected. Remind families we have alternate means of communication available.

 

If a resident is put under surveillance because of symptoms: Contact the resident(s) family and inform them theirfamily member is under surveillance and use talking points above to give a status update on their health.

 

Admission Consideration Guidelines related to COVID-19

Purpose: To provide facilities with guidelines related to admissions during the COVID-19 pandemic.

Guidelines:

1. Admissions department will review each referral for signs and symptoms of communicable disease, including theCOVID-19 surveillance
2. All residents are required to be tested for COVID-19 prior to admission
3. Residents who are being treated at the hospital for a communicable disease should be reviewed with the Community Nurse to assist in making an admission decision. Guidelines to be considered include:
   1. If a positive influenza diagnosis is present, determine if the resident is on Tamiflu, and the date treatment was initiated.
   2. Symptomatic of COVID-19 Positive Residents:
      
      19. Per MDHHS, facilities are able to provide care to residents who either become symptomatic or have tested positive for COVID-19. Standard of care includes placing in droplet/contact precautions, notifying the local health department and providing supportive care. If a resident’s clinical condition changes and requires a higher level of care than can be accommodated at the facility, considerationshould be given to transport the resident to an acute care setting for additional
   3. COVID-19 Patients Discharging from the Hospital:
      1. CDC recently updated guidance regarding the disposition of hospitalized patients and thediscontinuation of transmission-based This guidance clarifies LTC residents do not need to remain hospitalized until transmission- based precautions can be discontinued, if they are clinically stable for discharge. Assisted living facilities may accept residents who previously tested positive forCOVID-19, as long as they have the capacity to follow CDC guidance for transmission-based precautions, which includes droplet/contact precautions for most cases. Care that includes procedures producing respiratory aerosol should continue in respirator precautions. Currently, decision will be made on a case-by- case basis with local public health departments. Criteria for discontinuation ofprecautions may include one of two options, but consult with local health department to help makethe determination of discontinuing:
         1. Time-since-illness-onset and time-since-recovery strategy (non-test- based strategy)
         2. No fever without use of antipyretic medication for 72 hours
         3. Respiratory symptoms are resolved/resolving
         4. Time since onset of symptoms 7 days or OR
         5. Test-based strategy
         6. No fever without use of antipyretic medication for 72 hours
         7. Respiratory symptoms are resolved/resolving
         8. Negative results of a molecular assay for COVID-19 from at least two consecutive specimens collected >24 hours apart.
      2. If the resident is considered clear for admission,

 

1. The Admissions department will relay diagnosis/symptoms and any other pertinent information such asinfluenza during the Pre-Admission meeting.
2. Admissions department will discuss with the Community nurse the appropriate room placement, the needfor isolation, or cohorting with another resident of like illness.
3. Specific team members should be assigned to care for residents showing symptoms of or who have confirmed cases of COVID-19 communicable disease and should not care for other residents in the facility
4. All necessary supplies will be in place prior to admission; PPE’s, oxygen,

5. For all admissions and readmissions, the COVID-19 testing tool will be initiated and completed for 14 days and extended as needed.
6. Admission Department/designee will meet with the resident shortly after arrival to discuss precautionarymeasures currently in place related to COVID-19.
7. Ideally, visiting restrictions will be discussed with the resident and family prior to admission including alternatewats to communicate with family and

 

Admitting a Resident with Suspected or Confirmed COVID-19

 Purpose: To provide guidelines for staff in caring for residents with suspected or confirmed COVID-19 to reduce the risk of transmission to other residents.

Fundamental Information

The following guidelines have been taken directly from the CDC guidelines with some clarifications or paraphrases for clarity.

Guidelines

 

1. If admitted, place a patient with known or suspected COVID-19 in a single-person room with the door The patient should have a dedicated bathroom or, if not available, a bathroom that is shared with someone with the same disease.
2. As a measure to limit staff exposure and conserve PPE, Hampton Manor will consider designating an area within the building, which dedicated staff to care for known or suspected COVID-19 residents. Dedicated means that staff are assigned to care only for these residents during their shift and should not be assigned to any other residents (non-COVID-19 residents) until the visitor restrictions have been
   • Determine how staffing needs will be met as the number of patients with known or suspected COVID-19increases and staff becomes ill and are excluded from Ideally assigning a nurse/CNA team together to manage a primary assignment would be best to mitigate cross contamination.
   • It might not be possible to distinguish residents who have COVID-19 from those residents with other respiratory viruses. As such, residents with different respiratory pathogens will likely be housed on the same unit. However, only patients with the same respiratory pathogen may be housed in the same room. For example, a resident with COVID-19 should not be housed in the same room as a resident with an undiagnosed respiratory
   • During times of limited access to facemasks, Hampton Manor will consider having staff remove only gloves and gowns (if used) and perform hand hygiene between residents with the same diagnosis (e.g. confirmed COVID-19) while continuing to wear the same eye protection and facemask (i.e. extended use). Risk of transmission from eye protection and facemasks during extended use is expected to be very
     • Staff must take caution not to touch their eye protection and respirator or
     • Eye protection and the facemask should be removed, and hand hygiene performed if they become damaged or soiled and when leaving the designated COVID-19
   • Staff should strictly follow basic infection control practices between residents (e.g. hand hygiene, cleaning and disinfecting shared equipment).
3. Limit transport and movement of the resident outside of the room to medically essential purposes. Whenever possible, perform procedures/tests in the resident’s
4. Consider providing portable x-ray equipment in resident cohort areas to reduce the need forresident transport.
5. To the extent possible, residents with known or suspected COVID-19 should be housed in the same room for the duration of their sate in the community or once cleared by their doctor or health department (e.g. minimize room transfers). Follow #7 below and terminal cleaning processes for disinfecting resident

 

5. Residents should wear a facemask to contain secretions during transport. If residents cannot tolerate a facemask or one is not available, they should use tissues to cover their mouth and
6. Personnel entering the room should use PPE as described
7. Once the resident has been discharged or transferred, staff, including housekeeping personnel, should refrain from entering the vacated room for 3 hours. After this time has elapsed, the room should undergo appropriate cleaning andsurface disinfection before it is returned to routine use.

 

Cleaning and Disinfection During COVID-19 Outbreak 

Purpose

 Cleaning and Disinfection During COVID-19 Outbreak

To increase the frequency of cleaning in high touch areas in response to national pandemic with the goal of reducing the risk of virus spread, including special cleaning and disinfection in order to provide a safe, sanitary environment and to prevent the development and transmission of infections to the extent possible.

Definitions: 

• “Cleaning” refers to the removal of visible soil from objects and surfaces and is normally accomplished manuallyor mechanically using water and detergents or enzymatic products
• “Disinfection” refers to a chemical destruction of pathogenic and other types of
• “Hand Hygiene” is a general tern that applies to hand washing, antiseptic hand wash and alcohol-based hand rubs.
• “Standard Precautions” refers to infection prevention practices that apply to all residents, regardless of suspected or confirmed diagnosis or presumed infection status.
• “Transmission Based Precaution” refers to a group of infection prevention and control practices that are used in addition to standard precautions for residents who may be infected or colonized with infectious agents that requireadditional control measures to prevent transmission

 

Guidelines:

1. Always follow manufacturer recommendations related to the use of disinfectants including dilution directions and contact times needed for
2. No cleaning should occur during mealtimes
3. Resident rooms where COVID-19 is not suspected:
   • Use standard precautions, for all rooms, unless transmission-based precautions are identified
   • Upon entering the residents room remove soiled or used items, medical supplies and equipment when applicable.
   • Empty trash receptable, close twist and tie plastic liner while still in the resident room. Sanitize inside and outof the trash and replace
   • Avoid high dusting when residents are in the room
   • Work from clean to dirty (begin cleaning at the entrance of the room, disinfecting all high touch surfaces, light switches, doorknobs, all exposed horizontal surfaces such as windowsills, resident furniture etc. Once and area is sanitized remember do not rewipe, working towards the resident personal
   • Dust mopping should be done before wet mopping
   • Clean from areas that are visibly clean and to areas usually visibly dirty or potentially contaminated
   • Only after cleaning the resident room should you move to disinfect resident bathroom
   • Light switches, doorknobs, handrails, faucets, sinks, tub/shower, toilet/toilet seat, flush handles etc.

 

• Before mopping place wet floor sign at the entrance of the resident room
• Floors
  • Dust mop resident room, then wet mop starting at the furthest point of the room
  • Wet mop resident bathroom
  • Remove sign when completely dry
• Use proper hand hygiene when room is completed

*change mop water after every 3-4 rooms or if visibly contaminated

 

4. Resident room where COVID-19 is suspected or presumed positive:
   • Utilize Standard Precautions, Contact Precautions, and Airborne Precautions and eye protection when caringfor patients with confirmed or possible COVID-19
   • Housekeepers will utilize EPA-registered disinfectants products that are qualified for use against SARS-CoV-2, the novel coronavirus that causes COVID-19. A list of available products can be found here:https://www.epa.gov/coronavirus
   • Housekeepers will follow guidance for cleaning and disinfecting an isolation room cleaning as described in the Infection Control Manual
   • The following measures should be followed between cleaning resident rooms in suspected or presumed positive locations:
     • After cleaning a resident room, remove the mop heads and process for washing
     • Towels should be placed in the plastic bags to go for washing
     • No reusable cleaning devised should be used in multiple rooms
     • Mop water should be changed between resident rooms

5. Staff cleaning resident rooms of where COVID-19 is suspected, presumed or confirmed should only be assigned these rooms and should not be assigned to clean other rooms. Staff should be placed in other areas during the duration ofthe
6. High touch common area cleaning and disinfecting:
   • Consistent surface cleaning and disinfecting will be conducted at least 3 times per 24 hours minimum with a detailed focus on high touch areas to include, but not limited to:
     • Lobby entrance (all flat surfaces)
     • Common spaces, TV rooms
     • Activity rooms
     • Nurses station
     • Public/staff restrooms
     • Alarm code pad or punch knobs
     • Dining rooms
     • Staff break rooms
     • Corridors
     • Handrails
     • Telephones
     • Sinks and Faucets
     • Light Switches
     • Doorknobs and levers

7. Standard precautions will be adhered to when cleaning any blood or body fluid spills, or soiled material that have thepotential to contain in these or other potentially contaminated substances:
   • Hand hygiene
   • Use of gloves, gown, mask, eye protection, or face shield
8. Cautionary signs such as wet floor signs will be utilized and posted prior to cleaning
9. Cleaning considerations include, but not limited to the following:
   • Dry cleaning procedures will be conducted before wet procedures
   • Clean from areas that are visibly clean and least likely to be contaminated to areas usually visibly dirty

 

• Clean from top to bottom (bring dirt from high levels down to floor levels).
• Clean from back to front areas

10. Cleaning carts will be placed against the corridor wall, near the area to be cleaned and will not block the door, trafficlanes or safety
11. Clean prior to disinfection as recommended by the manufacturer of the product(s) being
12. Disinfectant solution will be prepared fresh daily and changed frequently in order to ensure
    • Follow manufacturer recommendations for dilution and frequency of changing of disinfectant solution
    • Follow manufacturer recommendations regarding appropriate contact time to ensure adequate disinfection
    • Change solution after completing a full cleaning cycle or when visibly contaminated
    • Verify products used to clean and disinfect surfaces in rooms under transmission-based precautions are effectiveagainst the pathogen of concern
    • Housekeepers will utilize EPA- registered disinfectant products that are qualified for the use against SARS-CoV-2, the novel coronavirus that causes COVID-19
13. Disinfect and store cleaning carts in designated locations. Lock carts while in use in resident care Do not leaveunattended in resident care areas.
14. Staff will ensure cleaning carts are checked and stocked with necessary supplies at the beginning of each shift.

 

References:

 Centers for Medicare & Medicaid Services, Dept. of HHS. Appendix PP: Guidance to Surveyors for LTC facilities. State Operations Manual: 42 C.F.R. 483.80, F880, November 2017 revision.

 Centers for Disease Control and Prevention (CDC). Guidelines for Environmental Infection Control in Healthcare Facilities (2003): Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC), April 2019 Update. Located at https://www.cdc.gov/infectioncontrol/guidelines/environmental/index.html. Accessed May 2019.

OVERVIEW OF PRECAUTIONS

 Policy & Procedure

 Policy:

 It is the policy of Hampton Manor to utilize precautions prevention measures that apply to resident care, regardlessof suspected or confirmed infection status of the resident, in any setting where healthcare is being delivered.Precautions are utilized to prevent and control and transmission of infectious organisms through direct andindirect contact. This evidence-based practice is designed to protect healthcare staff and residents by preventingthe spread of infectious among residents and ensuring staff do not carry infectious pathogens on their hands orvia equipment during resident care.

Types of transmission:

• Direct Contact Transmission (Person-to-Person): Occurs when microorganisms carried by resident/staff are transferred from an infected or colonized person to another person. Direct contact transmission may befrom infectious organisms such as bacteria, viruses or parasites and may be transmitted by direct contact(skin to skin).
• Indirect Contact Transmission: Involves the transfer of an infectious agent through a contaminatedinanimate object or Indirect contact transmission may be transmitted from staff and residentcare equipment.

Procedure:

 Hand Hygiene:

 Hand Hygiene means cleaning your hands by using either handwashing (washing hands with soap and water), antiseptic hand wash, antiseptic hand rub (i.e. alcohol-based hand sanitizer including foam or gel). Gloves maybe used including but not limited to:

 

• At the beginning and end of your shift
• Before eating
• Food and medication preparation areas
• Before and after glove use
• Before and after having direct contact with a resident’s intact skin. After contact with blood, body fluids orexcretions, mucous membranes, non-intact skin, or wound dressings
• After contact with blood, body fluids, visibly contaminated surfaces or after contact with objects in the resident’s
• Gloves changed and hand hygiene performed before moving from a contaminated-body site to a clean-body siteduring resident care
• After contact with inanimate objects (including medical equipment) in the immediate vicinity of the resident
• Before an aseptic task
• During active outbreaks
• Before and after PPE removal
• After using a restroom
• Assist residents with hand hygiene as

 

Use of PPE (gloves, gowns, facemasks)

The use of PPE during resident care is determined by the nature of staff interaction and the extent of anticipated blood, body fluid, or pathogen exposure to include contamination of environmental surfaces. Supplies necessary foradherence to proper PPE use are readily accessible in the facility. PPE includes but is not limited to the following:

• Gloves
• Gowns
• Appropriate moth, nose, and eye protection (e.g. facemasks, face shield)

Respiratory Hygiene/Cough Etiquette:

• Areas for dispensers of ABHR and supplies for hand washing where sinks are
• Have tissues readily available to cover mouths when coughing
• During times of increased prevalence of respiratory infections in the community, facemasks will be availableand should offer facemasks to coughing or sneezing visitors and other symptomatic
• Postings signs in the facility with instructions for family/visitors who have respiratory infections or other communicable
• Request ill visitors to consider refraining from entering the facility until the respiratory infection subsides(evaluated case by case).
• Equipment or items in the resident environment likely to have been contaminated with infectious fluids or other potentially infectious matter must be handled in a manner so as to prevent transmission of infectious

 

Safe Handling of Equipment/Cleaning and Disinfecting of Contaminated Equipment

• Proper use and cleaning of fingerstick and point-of-care testing equipment
• Routine cleaning and disinfection of high-touch surfaces in common areas, resident rooms and at the time of discharge.
• Privacy curtains in the resident’s rooms should be changed when visibly dirty by laundering or
• Proper cleaning/disinfection of resident care equipment including equipment shared among

 

Occupational health policies:

• Reporting of staff illnesses and the facility evaluating work restrictions written by physicians
• Prohibiting contact with residents or their food when staff have potentially communicable diseases or infected skin lesions

 

INFECTION CONTROL PROGRAM

 Hand Hygiene Policy & Procedure

 

 Policy:

 The facility must establish and maintain an infection control program including hand hygiene procedures followedby staff involved in direct resident contact (483.80(a)(2) and requires staff to follow hand hygiene practicesconsistent with accepted standards of practice. (483.80(a)(e)(f)

Definition: Hand Hygiene means cleaning your hands by using either handwashing (washing hands with soap andwater), antiseptic hand wash, antiseptic hand rub (i.e. alcohol-based hand sanitizer including foam or gel – ABHR).

 

Procedure:

Cleaning your hands reduces:

• The spread of potentially deadly germs to residents and others
• The risk of healthcare provider colonization or infection caused by germs acquired from the resident

When to clean your hands:

• At the beginning and end of your shift
• Before eating
• Food and medication preparation areas
• Before and after having direct contact with a resident’s intact skin
• After contact with blood, body fluids or excretions, mucous membranes, non-intact skin, or wound dressings
• After contact with blood, body fluids, visibly contaminated surfaces or after contact with objects in the resident’sroom
• After contact with inanimate objects (including medical equipment) in the immediate vicinity of the resident
• Before and aseptic task
• If hands will be moving from a contaminated-body site to a clean-body site during resident care
• After known or suspected exposure to Clostridium difficile
• After known or suspected exposure to patients with infectious diarrhea
• Before and after PPE use
• After using a restroom
• Encourage and assist residents with hand washing as necessary

 

Methods to clean your hands:

• Use of antiseptic soaps and detergents are the next most effective, non-antimicrobial soap is the least effective
• ABHR are the preferred method for cleaning hands in the healthcare setting if hands are not visibly dirty
• Soap and water are recommended for cleaning visibly dirty hands

 

CDC Guidelines for Hand Hygiene in Healthcare Settings recommends:

• When cleaning your hands with soap and water, wet your hands first with water, apply the amount of product recommended by the manufacturer to your hands, and rub your hands together vigorously for at least 15seconds, covering all surfaces of the hands and fingers
• Rinse your hands with water and use disposable towels to Use towel to turn off the faucet
• Avoid using hot water to prevent drying of skin

 

Procedure for alcohol-based hand sanitizer-ABHR:

• Place ABHR on hands and rub hand together
• Continue to cover all surfaces until hands feel dry
• Approximately 20 seconds or per manufacturer’s recommendations
• Maintain healthy skin on your hands

 

Hand and Nail Care

• Lotions and creams may prevent and decrease skin dryness that happens from cleaning your hands frequently, preventing breakdown of the skin
• It is recommended that healthcare providers maintain healthy, clean fingernails when having direct contactwith residents and during food preparation

 

STANDARD PRECAUTIONS

Policy and Procedure

Policy:

 

It is the policy of this facility to utilize “Personal protective equipment (PPE)”: protective items or garments worn toprotect the body or clothing, protect residents and staff from cross- transmission of infection or communicable disease.

 

“Standard Precautions” Infection prevention practices that apply to residents, regardless of suspected orconfirmed diagnosis or presumed infection status and is based on the principle that all blood, body fluids,secretions, excretions except sweat, regardless of whether they contain visible blood, non-intact skin, and mucousmembranes may contain transmissible infectious agents.

 

Standard precautions include but not limited to hand hygiene, use of PPE such as: gloves, gown, mask, eye protection, face shield, respiratory hygiene and cough etiquette, safe injection practices, and safe handling ofequipment and linens.

 

Procedure:

Exposure includes but not limited to:

• Urine
• Feces
• Saliva
• Blood or blood visible in body fluids
• Non-intact skin
• Tubes with drainage
• Mucous membranes
• Performing invasive procedures including venipuncture
• Drainage from wound
• Use proper hygiene before and after contact with residents
• Use PPE during resident care is determined by the nature of staff interaction and the extent of anticipated exposure
• Wear gloves before care starts and removed them after contact with blood or body fluid, mucous membranes, wound drainage, saliva, feces, urine, non-intact skin, drainage tubes or performingvenipuncture or any invasive procedure
• Gloves are changed and hand hygiene performed before moving from a contaminated-body siteto a clean-body site during resident care
• Wear gowns for direct resident contact if the resident has uncontained secretions or excretions or withcontaminated or potentially contaminated
• Wear appropriate mouth, nose, and eye protection (e.g. facemasks, face shield) for procedures that ae likelyto generate splashes or sprays of blood or body fluids
• Discard PPE appropriately after resident care prior to leaving room followed by hand hygiene
• the facility ensures necessary supplies for adherence to proper PPE use (e.g., gloves gowns,
• masks) and are readily accessible in resident care
• Handle equipment or items in the resident’s environment that are likely to have been contaminated withinfectious body fluids in a manner to prevent transmission of infectious
• Store lab specimens in non-leak biohazard identified containers and placed in a designated refrigeratoruntil picked up by the
• Use blood spill kits provided by Hampton Manor along with EPA registered disinfectant for clean-upprocess of blood spills
• Handle soiled linen as little as possible and contain in appropriate plastic bags
• Do not place soiled linen on floor or furniture

 

Interim COVID-19 Visitation Policy

Policy:

This facility will restrict visitation of all visitors and non-essential health care personnel for the duration of the declared national and public health emergency related to COVID-19. Exceptions will be in accordance with current CMS directives and CDC recommendations, or as directed by state government (whichever is more stringent).

Definitions:

“Restricting” visitation means the individual is not allowed in the community at all “Limiting” visitation meansthe individual is allowed to come into the community in certain

compassionate situations, such as end-of-life situations, but with limited access in the community and with certainconditions to prevent the potential spread of infection.

Covid Policy

Explanation:

1. The Infection Preventionist will monitor the status of the COVID-19 situation via the CDC websites and local/state health department and will keep facility leadership informed of the current directives/recommendationsand the need for restricting
2. The community will communicate this visitation policy though multiple channels, instructing visitors to defer visitation until further notice. Examples include signage, calls, letters, social media posts, emails, and recorded messages for receiving
3. Non-essential staff, as designated in emergency preparedness plans, will be notifies through routine and emergency communication procedures for staff.
4. Decisions about visitation during an end of life situation will be made on a case-by-case basis
5. When the community is under Restricted Visitation, all staff and essential health care workers will be screened using surveillance questions and temperature reading upon entry into the Individuals will not be permitted if he/she has symptoms such as a fever, shortness of breath, sore throat, if the individual has been exposed to someonediagnosed with COVID-19, or if the individual has traveled outside the country with the past 14 days.
6. If a compassionate visitation is permitted due to an end of life situation, the following protocols will be followed:
   1. One visitor at a time will be permitted
   2. Visitors will be screened for fever or respiratory illness prior to entry. Those with symptoms of a respiratorinfections (fever, cough, shortness of breath, sore throat) will not be permitted to
   3. Each visitor will be required to perform hand hygiene and wear a face mask. Additional personal protective equipment (PPE) will be required in accordance with transmission- based Each will be remindedto frequently perform hand hygiene.
   4. The visitor is limited to the resident’s room or other location designated by the facility
   5. The visitor must refrain from physical contact with residents and others while in the For example, practice social distances with no handshaking or hugging, and remaining 6 feet apart.
   6. Modify interactions with volunteers, vendors, EMS personnel, transportation providers, and other practitioners to prevent any potential transmission
7. Special considerations:

 

1. Essential Health care workers: Healthcare workers will be allowed to come into the community as long as they meet current CDC guidelines for health care workers. Screening for fever and respiratory symptoms apply in accordance with surveillance procedures
2. Surveyors: Screening for fever and respiratory symptoms along with requesting hand hygiene apply. Inform them of facility policy regarding standard and transmission-based
3. Ombudsman: Access will be restricted except in compassionate care situations and will be reviewed on a case-by-case basis. The community will arrange for alternative communication with the

8. Advise any visitor to monitor for signs and symptoms of respiratory illness and report to community if evidentwithin 14 days after visiting the
9. Resident-to-resident visitation:
   1. Communal dining and all group activities has been canceled
   2. Remind residents to practice social distancing and perform frequent hand hygiene
   3. Restrict non-affected residents from entering rooms of resident suspected/confirmed to have COVID-19
10. Offer alternatives to visitation, such as virtual communications (phone, video-communication), and be alert to psychosocial

 

Reference:

Centers for Medicare & Medicaid Services. QSO-20-14-NH: Guidance for Infection Control and Prevention ofCoronavirus Disease 2019 (COVID-19) in Nursing Homes (3-13-20 revision).

 

Team Member Illness 

Purpose: To assist team members in identifying when they should not report to work.

Fundamental Information:

Guidelines

If a team member becomes ill at work:

1. Team members who become ill at work should immediately put on a mask and report symptoms to their supervisor
2. Team members should be assessed for symptoms and sent home allowing for further evaluation of symptoms
3. Team members should monitor themselves for fever and symptoms of respiratory infection and contact their doctor
4. If the symptoms are in line with COVID-19, the team member should self-isolate for 14 days and contact the healthdepartments for further instructions and the potential need for testing
5. The community nurse and/or community physician (if applicable) should be notified
6. The community Infection Preventionist should begin tracking the team member’s illness using the Staff Call in Log During COVID-19 and track their symptoms tow times per day. An individual log should be used to document the team member self-reported temperature, symptoms, and results of any testing.

 

If a team member believes he/she has had potential or actual exposure to someone with COVID-19

1. If you are sick, please stay home
2. Employees currently not allowed to work because of pervious guidance may return to work if The employee must adhere to community requirements for self-monitoring and continue to closely monitor his or hercondition.
3. In the context of sustained community transmissions of COVID-19, all staff are at risk for unrecognized exposures. Therefore, all staff should self-monitor for fever with twice-daily temperature measurements and for symptoms consistent with COVID-19
4. If you are a Hampton Manor employee who has had a known high-risk exposure to a resident(s) withconfirmed COVID-19, even though the employee can continue to work, extra care to monitor health shouldbe There is no requirement for 14-day quarantine of employees with high-risk exposures in thesetting of sustained community.
5. MDHHS advises against testing of any asymptomatic individuals with or without an exposure to COVID-19, including healthcare
6. If you feel overwhelmed and need support to cope with the situation, contact the SAMHSA Disaster DistressHotline at 800-085-5990.