AHCA Coronavirus Guidance
AHCA has provided the following guidance for long-term care facilities regarding COVID-19:
- To decrease the risk of viral outbreaks in nursing centers, two processes need to be in place.
- First, efforts should focus on how to decrease the introduction of viruses into a facility.
- Second, steps to decrease the spread of a virus between residents need to be in place and followed consistently.
- Even then, outbreaks may still occur. Facilities should have a process to limit the spread of a virus and treat individuals with an infection to decrease the risk of illness exacerbation, hospitalization and in severe cases, death.
- Steps to help prevent the introduction of a virus into nursing centers, or any health care facility, include:
- Keeping all ill individuals from visiting the facility, including family, volunteers and employees, or restricting their interaction with residents.
- Requiring individuals visiting a facility to wear a mask when viral infections are at increased levels in the community (e.g. influenza).
- Encouraging frequent hand hygiene by making alcohol-based hand sanitizer dispensers readily available, in locations such as in or near each resident’s room, as well as in the entry area and common areas.
- Immunization of health care workers (e.g. influenza, measles, diphtheria, pertussis, chicken pox) or limiting health care workers physical interaction with residents when not immunized or using masks when such viral infections are found at increased levels in the community.
- Steps to help decrease the risk of viral spread within a facility include:
- Ongoing hand hygiene at high levels. This can be achieved with readily available alcohol-based hand sanitizers in locations such as in or near each resident’s room, common areas, etc.
- Regular and frequent internal monitoring systems of hand hygiene with regular feedback to staff.
- Visual reminders that hand hygiene helps residents stay healthy.
- Early identification of viral infections that cause upper respiratory illness (e.g. “colds, “flu,” or “winter crud”) that lead to steps that prevent viral spread. Preventative measures include early contact isolation and droplet protection for individuals with flu-like symptoms before a definitive diagnosis is made. This includes keeping ill individuals away from healthy individuals (e.g. ideally by cohorting ill residents together, though cohorting may not be possible given the physical space and structure of facilities).
- Use of masks on residents with symptoms if they need to leave their rooms, which should be severely restricted.
- Use of personal protective equipment by staff and visitors for droplet protection.
- Use of appropriate cleaning products on surfaces that are cytotoxic for common viral infections and changing these cleaning products when the harder to kill infectious agents are identified, such as C. diff, norovirus and adenovirus. These diseases and infections require special cleaning products, which should be readily available to the facility staff.
- CMS issued infection control regulations in November 2016. These regulations were designed to help decrease the risk of infectious outbreaks in nursing centers and require each nursing center to have an infection control plan that must describe:
- An infection prevention and control program. The facility must establish an infection prevention and control program that includes an antibiotic stewardship program. The facility must also designate at least one infection preventionist.
- A system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility.
- When and to whom possible incidents of communicable disease or infections should be reported.
- Standard and transmission-based precautions to be followed to prevent spread of infections.
- When and how isolation should be used for a resident, including but not limited to the type and duration of the isolation, depending upon the infectious agent or organism involved.
- A requirement that the isolation should be the least restrictive possible for the resident under the circumstances.
- The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease.
- The hand hygiene procedures to be followed by staff involved in direct resident contact.
- The CMS regulations also require each nursing center to designate at least one employee to serve as an infection preventionist, who is both a clinician (e.g. nurse) and has received additional training and certification in infection control.
- There are three training programs available, including one designed by AHCA. They all require approximately 20 to 25 hours of training.
- AHCA has recommended several steps to help decrease the risk of future viral outbreaks in nursing centers:
- AHCA has offered to provide a certificate course for free to those centers who provide care to high risk individuals (e.g. pediatrics, ventilators, HIV, transplants, and ESRD).
- State health departments should ensure each nursing center has alcohol-based hand sanitizers that are readily available to each room and at entry to the facility as well as in common areas for staff and visitors.
- State health departments should ensure all health care workers receive the influenza vaccine. If a worker chooses to decline the vaccine during periods of time when the there is an increase in influenza virus in the community, that individual should be required to wear a mask. If they are unable to wear a mask, they should not provide direct patient care. Several states and hospitals have adopted this type of approach.
- State departments of health should assure health care facilities use appropriate cleaning supplies that are cytotoxic to common viruses and pathogens (per Centers for Disease Control and Prevention and Environmental Protection Agency labeling for claims against common viruses and pathogens). All health care facilities should have a supply of additional cleaning agents for hard to kill pathogens when such pathogens are identified or suspected (e.g. C. diff, adenovirus, norovirus).
For questions, contact Mary Jane Carothers, VP, Quality Improvement and Clinical Affairs, at 800-422-3106.