Long-term Care Facilities (LTCFs) - HAN
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Overview
Resources below aim to provide interim guidance for the prevention and control of COVID-19 in LTCFs.
Given the high risk of spread once COVID-19 enters a LTCF, facilities must act immediately to protect residents, families, and staff from serious illness, complications, and death.
Join the CDPH SNF Team for the COVID-19 Roundtable webinars to learn about any updates related to COVID-19, see side bar for dates and times.
Given the high risk of spread once COVID-19 enters a LTCF, facilities must act immediately to protect residents, families, and staff from serious illness, complications, and death.
Join the CDPH SNF Team for the COVID-19 Roundtable webinars to learn about any updates related to COVID-19, see side bar for dates and times.
Federal/State Guidance Documents
- Illinois Executive Order 2022-21 issued 10/12/2022
- Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (CDC)
- Updated Interim Guidance for Nursing Homes and Other Licensed Long-Term Care Facilities (IDPH) Updated 11/4/22
- IDPH guidance covering restrictions for nursing homes and other long-term care (LTC) facilities that provide skilled nursing personal care (e.g. skilled nursing facilities). This guidance also covers infection prevention and control, visitation, communal dining, group activities, beauty/barber services, offsite outings, testing, screening, PPE, etc.
- Interim COVID-19 Guidelines for Assisted Living, and other Higher Risk Community Congregate Living Settings (IDPH) Updated 3/9/23
- IDPH guidance covering restrictions for assisted living facilities. This guidance also applies to other Illinois non-skilled facilities such as supportive living, shared housing establishments, sheltered care, and specialized mental health rehabilitation facilities (SMHRF), whose staff provide non- skilled personal care, similar to that provided by family members in the home.
- IDPH guidance covering restrictions for assisted living facilities. This guidance also applies to other Illinois non-skilled facilities such as supportive living, shared housing establishments, sheltered care, and specialized mental health rehabilitation facilities (SMHRF), whose staff provide non- skilled personal care, similar to that provided by family members in the home.
- Guidelines for the Prevention and Control of Influenza Outbreaks in Illinois LTC Facilities (IDPH)
- Skilled Nursing and Intermediate Care Facilities Code
- CMS QSO-20-38-NH (Testing Requirements)
- CMS QSO-20-39-NH (Visitation)
- CMS QSO-22-15-NH (Emergency Blanket Waivers)
- CMS QSO-22-25-CLIA (SARS-CoV-2 Tests on Asymptomatic)
COVID Data & Reporting
- SNF Case Reporting Form (CDPH)
- All staff and residents COVID cases, including those who tested positive via a rapid antigen test, must be reported to CDPH.
- CDC COVID Data Tracker: Transmission Map
- Map with current COVID-19 community transmission for Cook County. Ensure that you are hovering over Cook County on the map and that Community Transmission is selected in the Data Type dropdown menu
- NHSN COVID-19 LTCF Module
- Guidance for NHSN enrollment, training, and CMS requirements. Facilities eligible to report data to NHSN’s LTF COVID-19 Module include nursing home/skilled nursing, intermediate care facilities for individuals with Intellectual disability (ICF/ID), and assisted living facilities.
- NHSN Weekly COVID Vaccination Reporting
- Protocols and training to track weekly COVID-19 vaccination data for residents and healthcare personnel (HCP) through NHSN.
- Telligen QI Connect
- NHSN reporting tips and support.
- FAQ: COVID-19 NHSN Data (CMS)
- I-CARE Enrollment Packet
- The I-CARE Registry is an electronic web-based immunization data registry operated by the Illinois Department of Public Health (IDPH), accessible only to enrolled users who have predefined roles.
Testing
Category1 | Vaccination Status | High Transmission2 | Substantial, Moderate, and Low Transmission2 | |
Residents (asymptomatic) | Not up to date and up to date | Not required | ||
Residents (new/readmissions) | Not up to date and up to date | Upon admission (i.e. day 0), day 2, and day 4 | Not required | |
Residents and Staff (close contact to confirmed case) | Not up to date and up to date | Day 1, day 3, and day 5 post-exposure3 | ||
Residents and Staff (symptomatic) | Not up to date and up to date | Immediately | ||
Staff (asymptomatic) | Not up to date and up to date | Not required |
1 Testing is not required if a resident or staff member has had COVID in the prior 30 days, unless newly symptomatic
2 Check the CDC Transmission Map to determine transmission levels in your county
3 Day 0 is day of exposure, test on day 1
Updated Interim Guidance for Nursing Homes and Other Licensed Long-Term Care Facilities (IDPH) Updated 11/4/22
- Page 8 details testing plan and response.
- Guidance with interpretation of and response to results of antigen tests used to diagnose new SARS-CoV-2 infections for symptomatic/asymptomatic residents and healthcare personnel.
- Product expiry update.
Evaluating and Managing Staff and Residents
- Active screening and taking temperatures before someone enters the facility is no longer required. Instead, facilities must establish a process to inform staff, residents, and visitors of recommended actions to prevent the transmission of COVID-19 by posting visual alerts.
- Evaluate residents at least daily when community transmission is high or when the facility is in outbreak. Evaluation should include sign/symptom assessment, monitor temperature, and assess respiratory status with pulse oximetry. For residents with COVID, increase evaluations to every 4 hours.
When a new case is discovered, initiate outbreak testing immediately (but not earlier than 24 hours after exposure), test regardless of vaccination status. - 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. - Report all positive cases using the SNF COVID-19 Report Form
Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure
- Work restrictions for HCP with SARS-CoV-2 infection and exposures
QSO-20-29-NH (CMS)
- CMS is requiring facilities to notify residents, family, and staff when COVID-19 cases are identified within the facility
- Notification procedures to residents and residents'’ next of kin, guardians, or emergency contact when that resident, another resident or a staff member is diagnosed with COVID-19
- Signage can be posted as a visual alert to prevent the transmission of COVID-19.
Visitation & Resident Activities
- Active screening and taking temperatures before visitors enter the facility is no longer required. Instead, facilities must establish a process to inform visitors of recommended actions to prevent the transmission of COVID-19 by posting visual alerts.
- Facilities should provide instructions on hand hygiene, limiting surfaces touched, and use of PPE according to facility policy.
- When visits occur in common areas, source control should be worn by the resident and their visitors when community transmission is high.
CMS Nursing Home Visitation Frequently Asked Questions Updated 3/10/22
Personal Protective Equipment
- When community transmission levels are high, staff must wear a well fitted FDA-approved facemask and eye protection while present in resident care areas
- When community transmission levels are not high, a mask must be used in the following circumstances:
- For individuals who have suspected or confirmed COVID (or other respiratory infections)
- 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
- CPDH strongly recommends that long-term care facilities maintain universal masking, even when the community transmission is not high.
CDC PPE Sequence for donning and doffing
- Printable PPE education, can be used to post in isolation/quarantine rooms.
- Map showing community transmission rates by county. Please note that community transmission level is not the same as community levels. Facilities should monitor at least once a week given that CDC updates the metric by Friday.
- Summary of strategies to optimize PPE supplies in healthcare settings during surge capacity when PPE supplies are stressed, running low, or absent.
- A spreadsheet-based model that will help healthcare facilities plan and optimize the use of PPE for response to COVID-19.
- Guidance focusing on protecting workers from occupational exposure to SARS-CoV-2.
- Designed for use by personnel who have been suitably trained and charged with the responsibility of developing and implementing a respiratory protection plan (RPP) that addresses exposure to aerosol transmissible disease (ATD) pathogens and other respiratory hazards in congregate care facilities and environments.
- Before wearing a respirator, workers must first be medically evaluated using the medical questionnaire or an equivalent method.
- Videos on fit testing, medical evaluations, respiratory protection for healthcare workers, the difference between respirators and surgical masks, donning & doffing, counterfeit respirators, maintenance and care, and the OSHA Respiratory Protection Standard.
- Information ranging from basic respirator facts to more complex subjects on respirator function and performance.
- Instructions on identifying work hazards and conducting hazard assessments.
Vaccinations
- Educate staff, residents, and family members about the benefits of receiving COVID-19 vaccinations
- Work with your pharmacy partner to coordinate COVID-19 vaccine clinics for residents and staff
- Allow staff who experience vaccine-related side effects to take sick time if needed
- Have a clear plan in place to evaluate and document religious or medical exemptions
- Ensure staff documentation of vaccination status and required testing are in accordance with CMS and executive orders
- Up-to-date requirements can change, check the CDC Immunization Schedule for the latest dosage requirements
- Flyers can be posted in high-traffic areas to inform residents on the new bivalent booster vaccine.
- Posters feature real healthcare staff from Chicago LTC facilities and can be posted in high-traffic areas to promote booster clinics in your facility. Each poster has a dedicated box at the bottom where you can add the dates to upcoming clinics or additional information specific to your facility.
- CDC Communities of Practice webinar originally presented on February 9, 2023. This 60-minute call highlights successful strategies to engage older adults, residents, and staff in long-term care settings.
- Information on each type of available COVID-19 vaccine and when are you considered up to date.
- Resources for healthcare providers related to the COVID-19 vaccines, including links to interim clinical recommendations.
- Resources for the general public related to the COVID-19 vaccines, including how to find a vaccine provider.
- Learn more about mRNA vaccines.
- An introduction to motivational interviewing for healthcare professionals.
IDPH Stay Up to Date Signage
Therapeutics
- Treatment has been shown to reduce the risk of severe COVID-19 disease and hospitalization, especially in the elderly.
- As soon as a resident is diagnosed with COVID-19, contact the resident’s medical provider to assess whether treatment is warranted.
- COVID-19 Therapeutics and Prophylaxis (CDPH)
- Overview of COVID-19 therapeutics and prophylaxis for non-hospitalized patients.
- COVID-19 Outpatient Treatment (IDPH)
- Over of monoclonal antibody and oral antiviral medications for COVID-19 made available under emergency use authorization for non-hospitalized patients.
- TREAT COVID-19 Flyer / TREAT COVID-19 Flyer (Spanish version)
- CDPH in partnership with the Chicago Internal Medicine Practice and Research are offering the rapid response evaluation and treatment of COVID-19 program, an added resource to help respond quickly to large outbreaks.
EVS/Housekeeping
- About List N: Disinfectants for COVID-19 (EPA)
- How to Use List N: find products effective against SARS-CoV-2 (CDPH)
- Cleaning and Disinfecting Guidelines (English) courtesy of King County, WA
- Cleaning and Disinfecting Guidance (Spanish) courtesy of King County, WA
- Sparkling Surfaces: Stop COVID-19's Spread Video (CDC)
- Keep long-term care and nursing home residents healthy by knowing how and when to clean and disinfect environmental and equipment surfaces.
- Options for Evaluating Environmental Cleaning (CDC)
- Develop a program to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients.
- CDC Environmental Checklist for Monitoring Terminal Cleaning
- Checklist evaluating the cleaning of objects in the patient zone.
- CDC Environmental Checklist Word Document
- CDC Environmental Cleaning Evaluation Worksheet Excel Document
Hand Hygiene
- Hand Hygiene Guidance in Healthcare Settings (CDC)
- Hand hygiene recommendations in healthcare settings, includes educational slides.
- FAQ: Use of Alcohol-Based Hand Rubs in Illinois Long-Term Care Facilities (IDPH)
- Guidance and regulations for alcohol-based hand sanitizer in long-term care facilities.
- Hand Hygiene Program Guide (APIC)
- The APIC Implementation Guide helps infection preventionists apply current scientific knowledge and best practices to achieve targeted outcomes and enhance patient safety.
- Hand Hygiene Audit Tools and Apps:
Travel
- Chicago Travel Advisory
- Community levels for the public, including guidance for domestic travel.
- COVID-19 International Travel Guidance (CDC)
- Travel guidance and requirements for international travel.
Staff Training
- Project Firstline (CDPH)
- CDC’s Project Firstline is a collaborative of diverse healthcare and public health partners that aims to provide engaging, innovative, and effective infection control training for millions of frontline U.S. healthcare workers as well as members of the public health workforce.
- Infection Prevention Training for Long-term Care Facilities (CDC TRAIN)
- The CDC 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.
- APIC Infection Preventionist
- Infection preventionist developmental path using the APIC competency model.
- CBIC Long-term Care Certification
- Between October 16, 2022-January 31, 2023, the long-term care certification examination will not be available. The exam application will re-open for regular testing on February 1, 2023.
LTCF Reporting
How to Report COVID-19 Cases to CDPH:
**NEW** Updated CDPH SNF Case Report Form
1. Report lab-confirmed resident and staff cases within 24 hours.
2. Facilities with no new cases must report at least once a week, by Thursday 12 pm (Noon).
3. Effective immediately facilities should not longer submit weekly facility summary reports, enter cases in the Case & Cluster form, or enter cases into the Breakthrough Case Report Form.
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