Overview

The Skilled Nursing Facilities and Assisted Living (SNFAL) team provides guidance and outreach to skilled nursing, assisted living, and supportive living facilities in the Chicago area.

Join the SNFAL team for our Chicago Long Term Care Roundtable webinars each month! The webinars cover COVID-19 updates and other infection control/prevention topics for nursing homes and long-term care facilities. We invite all facility leadership to complete this survey to receive calendar invites for future webinars.

COVID-19

COVID-19 (coronavirus disease 2019) is a disease caused by a virus named SARS-CoV-2. It is primarily transmitted from person to person following close exposure to respiratory fluids carrying infectious virus.

Precautions: For residents with mild to moderate illness who are not moderately to severely immunocompromised, discontinue isolation when at least 10 days have passed since symptoms first appeared and at least 24 hours have passed since last fever without the use of fever-reducing medications and symptoms have improved. HCP who enter the room of a resident with suspected or confirmed SARS-CoV-2 infection should use a NIOSH approved particulate respirator with N95 filters or higher, gown, gloves, and eye protection.

Reporting: Report all staff and resident COVID cases. The table below shows COVID-19 reporting requirements for skilled nursing and assisted living facilities. There may be a need to report cases and/or outbreaks to multiple entities. Reporting to one does NOT satisfy the need to report to the others.
Reporting Requirements Skilled Nursing Assisted Living
CDPH Report all staff and resident COVID cases to the SNF Case Reporting Form Report all staff and resident COVID cases to the Communicable Disease Reporting Form
OHCR (facilities licensed by IDPH) Report all staff and resident COVID cases to the Office of Healthcare Regulations (OHCR)
*same form is used to report any serious incident or accident and communicable disease
Report all staff and resident COVID cases to the Office of Healthcare Regulations (OHCR)
*same form is used to report any serious incident or accident and communicable disease
NHSN (CMS certified facilities) Report all staff and resident COVID cases AND vaccination using the SAMS portal N/A
Testing: Facilities should have a written COVID-19 testing plan and response strategy in place, below are testing requirements outlined in the IDPH guidance.
Category Skilled Nursing Assisted Living
Residents (asymptomatic) Not required Not required
Residents (new/readmission) At the discretion of the facility Not required
Residents and Staff (close contact to confirmed case) Day 1, day 3, and day 5 post-exposure
(Day 0 is day of exposure)
Day 5 post-exposure
(Day 0 is day of exposure)
*Healthcare staff follow skilled nursing guidance
Resident and Staff (symptomatic) Immediately Immediately
*Testing is not required if a resident or staff member has had COVID in the prior 30 days, unless newly symptomatic

Outbreak Guidance: When a new case is discovered, initiate outbreak testing immediately (but not earlier than 24 hours after exposure), test regardless of vaccination status. Facilities can choose to investigate an outbreak using contact tracing or a broad-based approach.
  • Contact tracing approach: test all residents and HCP identified as close contacts or who had a high-risk exposure. Test on day 1, day 3, and day 5. If no additional cases are identified no further testing is required. If additional cases are identified, facilities should expand testing according to the distribution and number of cases (i.e. unit or facility wide testing).
  • Broad Based approach: requires testing of all residents and HCP when a single case of COVID-19 is identified, if unable to complete contact tracing. Test every 3-7 days until there are no more positives cases identified for 14 days.
HCP must wear a well-fitted mask while on the unit/floor experiencing an outbreak. Facilities should consider requiring an N95 respirator and eye protection during all resident care on the affected unit or floor.

Source Control
Masking is recommended in the following circumstances:
  • For residents who have suspected or confirmed COVID when out of their rooms (COVID+ residents should only be out of room for medically necessary reasons)
  • For staff returning to work on day 8 with a negative rapid test (must wear for 10 days from positive test)
  • For individuals with respiratory infections (e.g. runny nose, cough, sneeze) until symptoms resolve
  • For individuals who had close contact or a higher-risk exposure to someone with COVID (for 10 days after last exposure)
  • For individuals who reside or work in a unit/area of the facility experiencing a COVID outbreak (for 14 days after the most recent case)
  • For individuals who have otherwise had source control recommended by public health authorities
When COVID-19 Hospital Admissions Levels are HIGH for Cook County, source control is recommended for:
  • Staff and visitors in nursing homes and other long-term care facilities when they are in common areas of the facility where they could encounter residents.
  • Newly admitted residents for 10 days following their admission (day 0 is the date of admission)
Treatment: Clinicians should consider COVID-19 treatment in patients with mild-to-moderate COVID-19 who have one or more risk factors for severe COVID-19.  There is strong scientific evidence that antiviral treatment reduces their risk of hospitalization and death. Treatment must be started as soon as possible and within 5-7 days of symptom onset.

Vaccination: CDC recommends the 2023–2024 updated COVID-19 vaccines: Pfizer-BioNTech, Moderna, or Novavax, to protect against serious illness from COVID-19. Set up a vaccination clinic with CIMPAR Vaccination Services-Chicago; CIMPAR can provide education and vaccine resources.

Additional Resources:

Influenza

Influenza (flu) is a respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. Influenza A and B viruses commonly cause illness in humans and seasonal epidemics. The incubation period is usually 1–4 days after exposure. Most adults with influenza shed the virus in the upper respiratory tract and are infectious from the day before symptom onset to 5–7 days after symptom onset. 

Precautions: Droplet precautions should be implemented for residents with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer.

Reporting: Report influenza outbreaks within 24 hours to the CDPH Influenza Outbreak Report Form. A influenza outbreak is defined as two or more cases of ILI occurring within 72 hours among residents in a unit of the facility with at least one of the ill residents having laboratory-confirmed influenza (i.e., reverse transcription polymerase chain reaction [RT-PCR], viral culture, or rapid test) OR two or more laboratory-confirmed cases of influenza within 72 hours among residents in a unit of the facility.

Vaccination: Everyone 6 months and older should get a flu vaccine every season with rare exceptions. Vaccination is particularly important for people who are at higher risk of serious complications from influenza. ACIP recommends adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: HD-IIV4, RIV4, or aIIV4. If none of these three vaccines are available, then any other age- appropriate influenza vaccine should be used. For additional information check the 2023-2024 ACIP Summary of Influenza Vaccine Recommendations.

Additional Resources:

Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. Infants and older adults are more likely to develop severe RSV and need hospitalization. People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.

Precautions: CDC recommends contact precautions for the duration of illness. However, for long term care, CDPH recommends droplet and contact precautions for residents with suspected or confirmed RSV for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer.

Reporting: SNFs should complete the RSV Outbreak Line List Template and email to CDPHHAIAR@cityofchicago.org for all RSV outbreaks. Assisted Living and Supportive Living should report outbreaks using the Communicable Disease Reporting Form.

Vaccination: Vaccines are available to protect older adults from severe RSV. Adults 60 years of age and older may receive a single dose of RSV vaccine using shared clinical decision-making. For additional information check the 2023 MMWR RSV Recommendations.

Additional Resources:
  • CDPH RSV Poster - Flyers can be posted in high-traffic areas to inform residents on the new RSV vaccine.

Gastroenteritis

Gastroenteritis is an inflammation of the lining of the stomach and intestines, causing an acute onset of severe vomiting and diarrhea. Infections causing gastroenteritis can be viral, bacterial, or parasitic in origin. 

Norovirus
Norovirus is a very contagious virus that causes vomiting and diarrhea. Norovirus infections spread very rapidly. The incubation period is 12–48 hours. Healthcare facilities and other institutional settings are particularly at-risk for outbreaks because of increased person-to-person contact. Norovirus transmission occurs primarily through the fecal–oral route, either through direct person-to-person contact or indirectly via contaminated food or water. Precautions: Use Contact Precautions for a minimum of 48 hours after the resolution of symptoms or to control institutional outbreaks.

C. difficile
Clostridioides difficile (C. difficile or C. diff) is a spore-forming, gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea (AAD) and colitis (an inflammation of the colon). Precautions: Use Contact Precautions for the duration of illness.

Reporting: SNFs should complete the Gastroenteritis Outbreak Line List Template and email to CDPHHAIAR@cityofchicago.org for all GI outbreaks. Assisted Living and Supportive Living facilities should report GI outbreaks using the Communicable Disease Reporting Form.

Additional Resources:

Legionellosis

Legionella bacteria are found naturally in freshwater environments, like lakes and streams. Legionella bacteria can become a health concern when they grow and spread in human-made building water systems. After Legionella grows and multiplies in a building water system, water containing Legionella can spread in droplets small enough for people to breathe in. Legionella bacteria can cause a serious type of pneumonia (lung infection) called Legionnaires’ disease and can also cause a less serious illness called Pontiac fever.

Precautions: Standard precaution, Legionnaires' disease is not normally spread from person to person.

Reporting: SNFs should report all cases to CDPHHAIAR@cityofchicago.org.  Assisted Living and Supportive Living should report cases using the Communicable Disease Reporting Form.

Prevention: There are no vaccines that can prevent Legionnaires’ disease. The key to preventing Legionnaires’ disease is to reduce the risk of Legionella growth and spread. All facilities need to develop a policy for testing its water supply for Legionella bacteria. The policy should include a facility risk assessment, testing protocols, control measures, and documented results with corrective action when needed per Administrative Code Section 300.70.

Additional Resources:

Scabies

Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite is spread by prolonged skin-to-skin contact with a person who has scabies. Symptoms occur 2–6 weeks after an initial infestation. For people who previously had scabies, symptoms appear much sooner, typically 1–4 days after exposure. Crusted scabies (Norwegian scabies) is a severe form of scabies that can occur in some persons who are immunocompromised, elderly, disabled, or debilitated. Persons with crusted scabies have thick crusts of skin that contain large numbers of scabies mites and eggs. Persons with crusted scabies are very contagious.

Precautions: Contact Precautions should be implemented for residents with scabies until 24 hours after initiation of effective therapy.

Reporting: SNFs should report outbreaks to CDPHHAIAR@cityofchicago.org. Assisted Living and Supportive Living should report cases using the Communicable Disease Reporting Form.

Additional Resources:

Invasive Group A Streptococcus

Bacteria called group A Streptococcus (group A strep, GAS) can cause many different non-invasive and invasive infections. The vast majority of GAS infections are relatively mild noninvasive illnesses, such as strep throat and impetigo. Invasive GAS infection (iGAS) is defined by a culture or molecular test of GAS from either a normally sterile site (e.g., blood, cerebrospinal fluid) or a wound culture in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome.

Precautions: Residents with pneumonia related to GAS should be on droplet precautions until 24 hours after initiation of effective therapy. Residents with major skin lesions related to GAS should be on droplet + contact precautions until 24 hours after initiation of effective therapy and until drainage stops or can be contained by dressing.

Reporting: SNFs should report all iGAS (invasive) cases to the Invasive Group A Strep Case Report Form. Assisted Living and Supportive Living should report cases using the Communicable Disease Reporting Form.

Additional Resources:

Tuberculosis

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. For most people with LTBI, M. tuberculosis remains in the inactive state in which the infected person has no symptoms and cannot spread the infection to others. But in other people, especially people who have a weak immune system, the bacteria become active, multiply, and cause TB disease. Progression to TB disease can take weeks to decades after initial infection. People with TB disease have symptoms or other manifestations of illness (e.g., an abnormal chest radiograph). The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.

Precautions: Airborne precautions should be implemented for residents with suspected or confirmed pulmonary TB, discontinue precautions only when resident on effective therapy is improving clinically and has 3 consecutive sputum smears negative for acid-fast bacilli collected on separate days. Airborne + contact precautions should be implemented for residents with extrapulmonary TB who have a draining lesion, discontinue precautions only when resident is improving clinically, and drainage has ceased or there are 3 consecutive negative cultures.

Additional Resources:

Transmission-based Precautions

Transmission-based Precautions are recommended to contain highly transmissible and/or epidemiologically important agents and are based on the mode of transmission of the specific pathogen. Transmission-based Precautions include Contact Precautions, Droplet Precautions, and Airborne Precautions.

In July 2019, the CDC released the Implementation of PPE Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms document. The CDC document introduced a new approach to Transmission-Based Precautions in nursing homes called Enhanced Barrier Precautions (EBP), which recommends gown and glove use for certain residents during specific high-contact resident care activities associated with MDRO transmission.
  • A Toolkit for Implementing PPE in Nursing Homes to Prevent the Spread of Multidrug and Extensively Drug-Resistant Organisms - (For Skilled Nursing Facilities Only) This toolkit aims to provide nursing homes with the necessary tools and resources to implement Enhanced Barrier Precautions (EBP) for residents with wounds requiring dressings or indwelling medical devices and successfully admit and care for those residents with an XDRO or epidemiologically important MDRO. This document summarizes best practices and assists with decision making when deciding whether to place a resident on contact precautions or EBP.
  • CMS QSO-24-08-NH - New QSO provides new guidance for State Survey Agencies and long term care (LTC) facilities on the use of enhanced barrier precautions (EBP) to align with nationally accepted standards. The new guidance related to EBP is being incorporated into F880 Infection Prevention and Control.
  • The following are examples of signs for Enhanced Barrier, Contact, Droplet, and Airborne Precautions that should be posted outside resident rooms when indicated.
  • CDC PPE Sequence for donning and doffing - Printable PPE education, can be posted in isolation rooms to remind staff how to safely put on and remove PPE.

Additional Resources

Federal/State Guidance: 
  • Skilled Nursing and Intermediate Care Facilities Code - Illinois administrative code for LTC.
  • LTC Facility Self-Assessment Tool - The 2019 Nursing Home Infection Control Worksheet (ICWS) is a collaborative effort by CMS and CDC and meant to be used by facilities as a self-assessment tool. It comprises both regulatory requirements and best practices in infection prevention and control. A facility that uses this ICWS will identify gaps in practice and have a "roadmap" that can lead to an improved infection prevention and control program.

Staff Training:
Infection Prevention Training for Long-term Care Facilities (CDC TRAIN) - The CDC online training course is designed for infection prevention and control (IPC) programs in nursing homes. The course is made up of 23 modules and sub-modules and can be completed in multiple sessions. 
CBIC Long-term Care Certification - Applications are now open. The LTC-CIP provides a standardized measure of the basic knowledge, skills and abilities expected of professionals working in the long-term care field. The LTC-CIP is offered worldwide. The exam is an objective, multiple-choice examination consisting of 150 questions.

EVS/Housekeeping:
Hand Hygiene: Respiratory Protection Plan:

Reporting Links

Skilled Nursing Facilities report:


Assisted and Supportive Living Facilities report:

Asset Publisher

Upcoming Events

View All
event-icon

06/28/2024 at 1:00 pm - 2:00pm cst

IDPH: Infection Prevention and Control Updates: Best Practice for Specimen Collection and Storage - June 28, 2024

Webinar

SIGN UP >
event-icon

06/27/2024 at 12:30 - 1:30 cst

CDPH LTC Roundtable Webinar - June 27, 2024

CDPH Webinar

SIGN UP >
event-icon

07/25/2024 at 12:30 - 1:30 cst

CDPH LTC Roundtable Webinar - July 25, 2024

CDPH Webinar

SIGN UP >
event-icon

08/29/2024 at 12:30 - 1:30 cst

CDPH LTC Roundtable Webinar - August 29, 2024

CDPH Webinar

SIGN UP >

LTCF Contact

For COVID-19 Long-Term Care Guidance And Support:
312-744-1100