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Long-Term Care (LTC) Facilities

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Long-term care facilities serve vulnerable populations that are at higher risk of contracting COVID-19. Residents’ age and health status put them at greater risk for severe COVID-19 complications and potential death.

Long-Term Care COVID-19 Response

9/30/2022 The Centers for Disease Control and Prevention (CDC) issued updated COVID-19 guidance on Sept. 23, 2022, regarding masking in healthcare settings. The updated CDC guidance does not affect the Secretary of Health’s Mask Order, which aligns with CDC’s recommendations for infection source control in healthcare settings. 

The mask order currently requires universal masking in health care settings, with few exceptions. The masking requirement in healthcare facilities is not tied to the end of the emergency declaration and does not end on Oct. 31. DOH feels strongly about protecting the health of the most vulnerable in these settings. Updated circumstances for when masks are required in health care settings are under review at this time. 

With the end of the emergency declaration on Oct. 31, DOH recognizes the state is on the road to recovery. Though this is not the end of the COVID-19 response in Washington, we have more prevention tools at our disposal now through testing, vaccination, and therapeutics. DOH remains committed to supporting all Washington state communities as we continue the fight against COVID-19. 

Long-Term Care (LTC) Facilities 

Long-term care facilities serve vulnerable populations that are at higher risk of contracting COVID-19. Residents’ age and health status put them at greater risk for severe COVID-19 complications and death. COVID-19 can quickly spread in congregate care settings.

Benton-Franklin Health District has been working with these facilities throughout Benton and Franklin Counties to ensure strong infection control guidance, availability of testing, and other measures to identify cases and minimize the spread of disease and protect these vulnerable populations.

 

Most current updates:

Interim Recommendations for SARS-CoV-2 Infection Prevention and Control in Health care Settings

 Effective October 31, 2022, DOH consolidated all health care guidance into one document in order to maintain consistency with the recommendations as well as make it easier to find the appropriate recommendations.

Guidance was updated to clarify language and to maintain consistency.The following substantive changes in recommendations are:

  • Updated management of staff, visitors, and patients entering a facility.
  • Updated to reflect that vaccination status is no longer used to inform source control, screening testing, or post-exposure recommendations.
  • Updated circumstances when use of eye protection is recommended.
  • Updated recommendations for testing frequency.
  • Clarified that screening testing of asymptomatic healthcare personnel, including those in nursing homes, is at the discretion of the healthcare facility.
  • Updated to note that, in general, asymptomatic patients no longer require empiric use of Transmission-Based Precautions following close contact with someone with SARSCoV-2 infection.
  • Updated to note that, in general, staff do not require restrictions from work following a higher risk exposure to someone with SARS-CoV-2 infection.
  • Updated screening testing recommendations for nursing home admissions.
  • Updated to continue to include Assisted Living, Group Homes, and other Residential Care Settings.

Considerations for interpretation of SARS-COV-2 antigen tests in Long-Term Care settings

  • Masking
      • The Secretary of Health Mask Order requires wearing a mask in some settings, regardless of vaccination status:
        • Health care settings including Long term care facilities.
  • Communal dining and activities:
      • Residents can participate in communal dining and activities regardless of vaccine status.
      • Continue to practice social distancing, hand hygiene and source control.
  • “Cohorting” for COVID-19
      • Cohorting positive residents in a single area allows dedicated health care workers to work only with residents with known COVID-19. This decreases the risk of spreading the virus from infected to uninfected residents. Facilities should prepare their COVID-19 dedicated unit following DOH’s Preparing your LTCF COVID-19 Unit (linked below).
      • Recommendations for Cohorting in Long-Term Care Facilities During a COVID-19 Outbreak:

Isolation and Quarantine Summary for Residents

Patients that are asymptomatic with an exposure to COVID-19 generally do not require quarantine. Exposed patients should wear source control for 10 days post-exposure. If Patient has not recovered from COVID-19 in the last 30 days, they should be tested immediately on post exposure day 1 (but not before 24 hours from exposure) day 3 and day 5.

Patients with an exposure to COVID-19 need to be placed in quarantine if they meet one of the following criteria:

  • Patient is unable to be tested or wear source control as recommended for the 10 days following their exposure
  • Patient is moderately to severely immunocompromised
  • Patient is residing on a unit with others who are moderately to severely immunocompromised
  • Patient is residing on a unit experiencing ongoing COVID-19 transmission that is not controlled with initial interventions
Table 4: Summary of COVID-19 Isolation and Quarantine
Quarantine Isolation
Days

For patient that meets criteria for quarantine, quarantine ends when:

10 Day Quarantine or 7-day Quarantine with negative tests on day 1, 3 and 5.:

Isolation ends for patients who are not severely immunocompromised 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 (for example cough, shortness of breath) have improved

Reason for TBP

The incubation period for COVID-19 is thought to extend to 14 days, with a median of 4-5 days from exposure to symptom onset. Most people with COVID- 19 who have symptoms will do so within about 11 days of infection.

If exposed to COVID-19, perform post-exposure testing.

It takes about 10 days for someone to stop being infectious after they become ill with COVID-19, which is why it is recommended that someone who tests positive for COVID-19 isolates for 10 days.

Recommendations for Health Care Workers Exclusion From Work

Summary of CDC’s recommendations for HCP exclusion from work according to staffing mitigation strategy

 

Work Exclusion for Health Care Personell

Mitigation Strategy
Conventional Capacity Staffing Contingency Capacity Staffing Crisis Capacity Staffing
Tested positive with COVID-19 Infection

If asymptomatic or mildly symptomatic with improving symptoms and fever free for 24 hrs. without fever- reducing medications, exclude from work for:

·  10 days OR

·  7 days with negative test** within 48 hours before returning to work

If asymptomatic or mildly symptomatic with improving symptoms and fever free for 24 hrs. without fever- reducing medications exclude from work* for at least 5 days since symptoms first appeared (day 0) with or without negative NAAT (PCR) or a series of two negative antigen tests taken 48 hours apart** No work restriction with prioritization considerations (for example, asymptomatic should be prioritized for early return to work)*
Asymptomatic with higher risk exposure

Post-exposure testing immediately (on post-exposure day 1, not earlier than 24 hours post exposure), post exposure day 3 and day 5.

Work restriction if:

·         HCP is unable to be tested for COVID-19 infection or wear source control for 10 days following exposure;

·         HCP is moderately or severely immunocompromised;

·         HCP cares for or works on a unit with patients who are moderately or severely immunocompromised;

·         HCP works on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions.

If work restriction applies, can return to work after either of following time periods:

·         If they do not develop symptoms and all viral testing as described for asymptomatic health care staff following a higher-risk exposure is negative, can return to work after day 7 following the exposure (day 0)

·         If viral testing is not performed, can return to work after day 10 following the exposure (day 0) if they do not develop symptoms.

*Healthcare facilities may consider allowing willing HCP who are infected with COVID-19 and are not immunocompromised to return to work earlier than conventional timeframes if implementing contingency or crisis staffing mitigation measures. Prior to agreeing to return to work, willing HCP should assess personal symptoms, current health status, and determine their personal readiness to safely return to work. Mitigation measures should be implemented sequentially (that is, implementing contingency before crisis)

** Either an antigen test or NAAT can be used when referenced in the criteria above. Some people may be beyond the period of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid turnaround time but are often less sensitive than NAAT. Antigen testing is preferred for symptomatic HCP and for asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days.

For additional information Interim Recommendations for SARS-CoV-2 Infection Prevention and Control in Health care Settings

Required COVID-19 Reporting for Facilities

Required COVID-19 Reporting

Washington Administrative Code WAC 246-101 requires laboratories to report all COVID-19 results to DOH and their Local Health Jurisdiction within 24 hours (including positive, negative (DOH only), inconclusive; and other results based on State Health Officer Letters). This reporting requirement applies to all facilities using POC or rapid screening tests for COVID-19. This includes clinics that are not traditionally a lab, such as long-term care facilities, schools, and correctional facilities.

Step 1 – Required reporting to DOH:

Option 1: Submit online to DOH via SimpleReports.  You can enroll in this process here SimpleReport

Options 2: Submit a Report Form (PDF) via fax to DOH at (206) 512-2126.  If you need to submit a line list, please contact BFHD for an approved template.

Step 2 – Required reporting to BFHD-LHJ:

Option 1: Report each case individually OR attach a BFHD approved template via  BFHD COVID-19 LTC Reporting Form (iths.org)

Option 2: Call BFHD to report cases

Skilled Nursing Facilities continue to report to NHSN / CDC

Testing

  • Community levels definition – positive tests divided by total number of tests performed within a 7-day period.
  • Community transmission definition – positive tests divided by total number of tests performed within a 7-day period x 100%.

Point of Care Testing

Request test supplies: https://app.smartsheet.com/b/form/a026d012a1ec47b78ff15a2f495de863

CLIA waiver information: https://www.doh.wa.gov/LicensesPermitsandCertificates/FacilitiesNewReneworUpdate/LaboratoryQualityAssurance/Licensing/Applications

Reporting POC tests:

Washington Administrative Code WAC 246-101 requires laboratories to report all COVID-19 results to DOH and their Local Health Jurisdiction within 24 hours (including positive, negative (DOH only), inconclusive; and other results based on State Health Officer Letters). This reporting requirement applies to all facilities using POC or rapid screening tests for COVID-19. This includes clinics that are not traditionally a lab, such as long-term care facilities, schools, and correctional facilities

LTC Visitation

A facility’s process to educate visitors and prospective visitors on core infection prevention practices should include:

  • Recommended actions to prevent transmission if they have:
    • a positive viral test for SARS-CoV-2
    • symptoms of COVID-19, or
    • close contact with someone with SARS-CoV-2 infection (for patients and visitors) or a higher-risk exposure (for healthcare personnel (HCP).
  • Performing hand hygiene before and after their visit.
  • Wearing source control (for example, facemask) always while in the facility.
  • Not being present in the patient room during aerosol generating procedures and other procedures.
  • If visiting a patient when PPE is indicated, how to properly wear PPE.
  • The risks associated with visitation should be explained to patients and their visitors so they can make an informed decision about participation.
  • Nonadherence to any of the infection principles outlined in the facility’s policy will result in denial of visitation.

LTC FAQ

What precautions are in place to prevent outsiders from introducing infection?
Please contact Facility

Do residents that leave facilities for medical and non-medical appointments need to be quarantined or isolated?

  • If they are residing at a Skilled Nursing Facility (SNF) and community transmission levels are high, residents are tested upon admission. If they test positive, they are isolated. 
  • If the resident of the SNF leaves the SNF for greater than 24 hours when community transmission levels are high they are tested upon return.If they test positive, they are isolated. 
  • If the resident has had an identified exposure and meets the quarantine guidelines below, they will enter quarantine. 
    • Patient is unable to be tested or wear source control as recommended for the 10 days following their exposure
    • Patient is moderately to severely immunocompromised
    • Patient is residing on a unit with others who are moderately to severely immunocompromised
    • Patient is residing on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions

Are LTC facilities required to notify residents and families if a positive COVID-19 case is identified in the facility?
Yes, DSHS requires facilities to notify all staff, residents, and families when a positive COVID-19 case is identified in the facility.

If I am concerned that a facility or agency policy is unsafe, what can I do?
If you have any concerns, please contact the LTC surveillance team at BFHD. You can contact us by email at eoc.operations.ltc@bfhd.wa.gov or call us at 509-460-4200.

If you feel that a LTC facility is in violation of state law, please file a complaint with Residential Care Services. Complaints to the Residential Care Services (RCS) Complaint Resolution Unit (CRU) will inform DSHS of potential violations of Safe Start for Long Term Care criteria. CRU staff will investigate complaints. 

The RCS Complaint Resolution Unit may be reached at 1-800-562-6078, or a complaint may be lodged online

Other Resources

Additional Guidance:

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