COVID-19 infection control

Skilled nursing facilities and home care providers brace for spread of COVID-19

Frail, elderly and sick patients with underlying health issues are among those most vulnerable to COVID-19, the infectious disease caused by the novel coronavirus first identified in the Wuhan province of China late last year. News over the weekend that the coronavirus was responsible for the deaths of 13 residents of a skilled nursing facility in Kirkland WA sparked new concerns about the potential impact on skilled nursing and home health patients as the infectious disease spreads across the U.S. The Centers for Medicare and Medicaid Services (CMS) has released a flurry of memorandums over the past few days about infection control and procedures, including a new list of FAQs designed to address common questions from health care providers. “While there is a great deal of information coming out almost daily, it is very important for health care providers to stay on top of this situation,” said J’non Griffin, owner and president of Home Health Solutions, a nationwide consulting and outsourcing firm which operates a long-term care division in addition to providing home care services. She recommends checking the CDC information page on the coronavirus here at the end of each day, if possible, to stay abreast of the evolving situation and no less frequently than every other day. Here’s a re-cap of where else to find helpful information. Prioritize infection control “New staff training in infection control and prevention is crucial right now for all skilled nursing facilities and home health agencies,” J’non said. “As of last week, CMS has prioritized infection control as the survey focus at hospitals and skilled nursing facilities in an attempt to contain and control the spread of COVID-19.” CMS issued a memorandum to state surveyors and accrediting organizations on March 4 suspending all non-emergency surveys in the nation’s hospitals and skilled nursing facilities and requiring inspectors to focus instead on infectious disease control and prevention. Inspectors will also continue to investigate immediate jeopardy situations and abuse. Home care providers should follow suit, J’non said. She encouraged agencies to re-examine their agency infection control programs, which are required under Medicare’s Conditions of Participation, and re-educate staff on proper precautionary measures and agency policy and procedures. Standard infection control procedures are in place for COVID-19, she said. “Strategies for infection prevention and control in the case of COVID-19 aren’t new,” J’non said. “The same protocol we would employ for control of any other infectious respiratory illness will be needed for the prevention and control of this coronavirus."

Facilities and home care agencies need to develop a plan for how they will evaluate health care personnel for symptoms, J’non said, and make certain they are prepared to handle a scenario in which many people become ill at the same, limiting staff resources. Where to find guidelines Facilities: CMS offers specific COVID-19 guidance to nursing homes in a PDF available here. Additional guidance for facilities is available here. Home health: CMS has not yet issued specific COVID-19 guidance for home health or hospice agencies. However, the National Association for Home Care & Hospice (NAHC) is offering guidance on its web site, available by clicking here. In addition, Home Health Solutions published a blog post on March 2 identifying four actions home health agencies need to take in response to the emerging threat of COVID-19, including the need to update CoPs-required emergency plans to include the new coronavirus as a specific threat addressed on the agency’s all-hazards Risks and Vulnerabilities Assessment. Patient testing and transfer Many of the initial and non-specific symptoms of COVID-19 are common among both home care patients and residents at skilled nursing facilities, including cough, shortness of breath, myalgia, fatigue, nausea, and diarrhea. Clinician judgment will be an important factor in determining whether to test for the coronavirus in their patients. A homebound patient who develops severe symptoms may require transfer to a hospital for a higher level of care, and clinicians will need to closely monitor the situation. Testing for COVID-19 remains limited at this time and is only available through the public health system and not through commercial testing labs, but is expected to become more widely available soon. Specific information for frontline clinicians, including a discussion of specific clinical presentation of the disease, known timeframes for complications, and guidance on clinical management of the disease is available from the Centers for Disease Control via recording at: (Note there are some audio difficulties during the recording, but audio does return.)

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