On March 5, 2020, the CDC Clinician Outreach and Communication Activity (COCA), a resource for emergency health professionals, hosted a call updating clinicians on preparing for COVID-19, or coronavirus. Healthcare settings, including skilled nursing and long-term care facilities, are some of the areas of greatest concern. Below is a summary of COCA’s best practices when addressing COVID-19 in a healthcare setting:
1) Identifying persons under investigation
As of yesterday, the criteria for evaluation of persons under investigation was expanded to a wider group of symptomatic patients. Clinicians should look to possible symptoms of COVID-19, such as fever, cough, and difficulty breathing, in determining if the patient should then be tested. Influenza should also be considered during testing and co-infection is possible. Testing of healthcare personnel should be considered if they have been exposed to an individual with a suspected case of COVID-19 or they exhibit even mild symptoms of COVID-19.
2) Applying infection prevention and control measures
While the CDC has learned a lot about COVID-19, there is still a great deal that is unknown. The best way to protect residents, visitors, and staff is to rely on the infection control measures already in place. This includes standard precautions, such as washing hands and disinfecting surfaces. Facilities should also take an aggressive approach to diagnosing individuals showing signs of any respiratory infection and place them in isolation where possible.
3) Assessing risks for exposures
It is currently optional, not mandatory, for facilities to verify absence of fever and respiratory symptoms when healthcare personnel report to work. Risk exposure should focus on source control, use of personal protective equipment (PPE), and the degree of contact with the resident. Healthcare providers are also advised to inform their employers if they have travel or community related exposure.
4) Optimizing the use of personal protective equipment supplies
The CDC anticipates an increased demand for N95 masks. Facilities should optimize the use of these masks by, for example, limiting them to use in symptomatic residents and using expired masks during training. The FDA has also issued an emergency use authorization for the use of certain other masks in healthcare settings. See Letter of Authorization and NIOSH-approved FFRs.
5) Managing and caring for patients (inpatient and at home)
If a resident is either a person under investigation or a confirmed case, provide supplies and a garbage bin outside the door of the resident’s room. Post signage on the door clearly describing the infection control precautions to be taken. A facility may also limit exposure by designating and training certain individuals, or a team, to care for persons under investigation or confirmed cases.
- CDC Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities
- CMS Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes
- California Department of Public Health
- Colorado Department of Public Health & Environment
Looking for information related to a specific state? Contact the authors for more information.